Update on hepatorenal Syndrome: Definition, Pathogenesis, and management

Hepatorenal syndrome (HRS) is acute kidney injury (AKI) that occurs without evidence of structural abnormalities in the kidneys in patients with liver disease. It is thought to be due to splanchnic vasculature dilatation that is associated with intense increase of renal arteries’ tone, leading to re...

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Bibliographic Details
Published in:Arab journal of gastroenterology 2022-05, Vol.23 (2), p.125-133
Main Authors: Habas, Elmukhtar, Ibrahim, Ayman R., Moursi, Moaz O., Shraim, Bara A., Elgamal, Mohamed E., Elzouki, Abdel-Naser
Format: Article
Language:English
Subjects:
Combined liver-kidney transplantation
Hepatorenal syndrome
HRS pathophysiology
Nitric oxide
Splanchnic vasodilatation
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Summary:Hepatorenal syndrome (HRS) is acute kidney injury (AKI) that occurs without evidence of structural abnormalities in the kidneys in patients with liver disease. It is thought to be due to splanchnic vasculature dilatation that is associated with intense increase of renal arteries’ tone, leading to renal cortex ischemia and AKI. Nitric oxide, endotoxins, neurohormonal changes, bacterial infection, high serum bilirubin and bile acids are examples for factors contributing to HRS development. Nevertheless, other unknown factors may have role in HRS pathophysiology. Hence, further discussion and research are needed to clearly understand HRS. Plasma volume restoration and vasoconstrictors are the cornerstone of HRS treatment. Others such as octreotide, noradrenaline, infection control, systemic inflammatory response prevention, shunting, and renal replacement therapy are currently used to manage HRS. Liver or combined liver and kidney transplantation is currently the ultimate cure for HRS. This review was written to help in better understanding the pathogenesis, diagnosis, and treatment options for HRS.
ISSN:1687-1979
2090-2387
DOI:10.1016/j.ajg.2022.01.005