Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. May 6, 2015; 4(2): 277-286
Published online May 6, 2015. doi: 10.5527/wjn.v4.i2.277
Management of hepatorenal syndrome
Halit Ziya Dundar, Tuncay Yılmazlar
Halit Ziya Dundar, Tuncay Yılmazlar, Department of General Surgery, Faculty of Medicine, Uludag University, Gorukle, 16285 Bursa, Turkey
Author contributions: Both authors contributed to this manuscript.
Conflict-of-interest: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Halit Ziya Dundar, MD, Department of General Surgery, Faculty of Medicine, Uludag University, Gorukle, 16285 Bursa, Turkey.
Telephone: +90-224-2952040 Fax: +90-224-4428398
Received: June 29, 2014
Peer-review started: June 29, 2014
First decision: August 14, 2014
Revised: December 29, 2014
Accepted: January 30, 2015
Article in press: February 2, 2015
Published online: May 6, 2015

Hepatorenal syndrome (HRS) is defined as development of renal dysfunction in patients with chronic liver diseases due to decreased effective arterial blood volume. It is the most severe complication of cirrhosis because of its very poor prognosis. In spite of several hypotheses and research, the pathogenesis of HRS is still poorly understood. The onset of HRS is a progressive process rather than a suddenly arising phenomenon. Since there are no specific tests for HRS diagnosis, it is diagnosed by the exclusion of other causes of acute kidney injury in cirrhotic patients. There are two types of HRS with different characteristics and prognostics. Type 1 HRS is characterized by a sudden onset acute renal failure and a rapid deterioration of other organ functions. It may develop spontaneously or be due to some precipitating factors. Type 2 HRS is characterized by slow and progressive worsening of renal functions due to cirrhosis and portal hypertension and it is accompanied by refractory ascites. The only definitive treatment for both Type 1 and Type 2 HRS is liver transplantation. The most suitable bridge treatment or treatment for patients who are not eligible for transplantation is a combination of terlipressin and albumin. For the same purpose, it is possible to try hemodialysis or renal replacement therapies in the form of continuous veno-venous hemofiltration. Artificial hepatic support systems are important for patients who do not respond to medical treatment. Transjugular intrahepatic portosystemic shunt may be considered as a treatment modality for unresponsive patients to medical treatment. The main goal of clinical surveillance in a cirrhotic patient is prevention of HRS before it develops. The aim of this article is to provide an updated review about the physiopathology of HRS and its treatment.

Keywords: Hepatorenal syndrome, Cirrhosis, Renal failure, Vasoconstrictors, Transplantation

Core tip: Hepatorenal syndrome (HRS) is a severe complication of chronic liver diseases and is usually associated with a poor prognosis. It is not a renal disease but a renal dysfunction that develops as a result of a systemic condition associated with liver failure. To prevent HRS by taking some preventive measures is possible and although the definitive treatment is liver transplantation, a rapid diagnosis and prompt initiation of the treatment leads to an important improvement in the prognosis. In this review, we cover the physiopathology, diagnosis and treatment options of HRS.