Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Nov 6, 2015; 4(5): 511-520
Published online Nov 6, 2015. doi: 10.5527/wjn.v4.i5.511
Hepatorenal syndrome: Update on diagnosis and treatment
Olga Baraldi, Chiara Valentini, Gabriele Donati, Giorgia Comai, Vania Cuna, Irene Capelli, Maria Laura Angelini, Maria Ilaria Moretti, Andrea Angeletti, Fabio Piscaglia, Gaetano La Manna
Olga Baraldi, Chiara Valentini, Gabriele Donati, Giorgia Comai, Vania Cuna, Irene Capelli, Maria Laura Angelini, Maria Ilaria Moretti, Andrea Angeletti, Gaetano La Manna, Department of Experimental, Diagnostic, Specialty Medicine, Nephrology, Dialysis, and Renal Transplant Unit, S. Orsola University Hospital, 40138 Bologna, Italy
Fabio Piscaglia, Division of Internal Medicine, Department of Digestive Diseases and Internal Medicine, Sant’Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy
Author contributions: Baraldi O and La Manna G designed the aim of the article, wrote the manuscript and made critical revisions; Valentini C, Donati G, Comai G, Cuna V, Capelli I, Angelini ML, Moretti MI, Angeletti A, Piscaglia F contributed equally to this work, generated the figures and wrote the manuscritps.
Conflict-of-interest statement: The authors do not have any disclosures to report.
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: Gaetano La Manna, MD, PHD, Professor, Department of Experimental, Diagnostic, Specialty Medicine - Dialysis, Nephrology and Transplantation Unit, S. Orsola University Hospital, Via G. Massarenti 9, 40138 Bologna, Italy.
Telephone: +39-51-2143255 Fax: +39-51-344439
Received: April 14, 2015
Peer-review started: April 15, 2015
First decision: May 13, 2015
Revised: August 13, 2015
Accepted: September 16, 2015
Article in press: September 18, 2015
Published online: November 6, 2015

Acute kidney injury (AKI) is a common complication in patients with end-stage liver disease and advanced cirrhosis regardless of the underlying cause. Hepatorenal syndrome (HRS), a functional form of kidney failure, is one of the many possible causes of AKI. HRS is potentially reversible but involves highly complex pathogenetic mechanisms and equally complex clinical and therapeutic management. Once HRS has developed, it has a very poor prognosis. This review focuses on the diagnostic approach to HRS and discusses the therapeutic protocols currently adopted in clinical practice.

Keywords: Hepatorenal syndrome, Cirrhosis, Acute kidney injury, Diagnosis, Treatment, Terlipressin, Liver support system

Core tip: Hepatorenal syndrome is a functional and potentially reversible form of kidney failure. The pathophysiological bases of this disease are complex and not fully understood. The aim of this review is to focus the current diagnostic approach and the updated therapeutic protocols adopted in clinical practice.