Current Therapies for Hepatorenal Syndrome.

Hepatorenal syndrome (HRS) is a feared common complication of patients with cirrhosis. This syndrome is mainly characterized by functional renal failure due to renal vasoconstriction in the absence of underlying kidney pathology. The pathogenesis of HRS is complex and a final result of an extreme underfilling of the arterial circulation secondary to an arterial vasodilation located in the splanchnic circulation. This phenomenon leads to a compensatory response with activation of vasoconstrictors that cause intense renal vasoconstriction and kidney failure. The diagnosis of HRS is based on established diagnostic criteria aimed at excluding nonfunctional causes of renal failure. However in recent years the diagnosis of renal failure in patients with cirrhosis has also been adapted to include the acute kidney injury criteria proposed by the acute kidney injury network. The prognosis of patients with HRS is poor, especially in those who have a rapidly progressive course. Liver transplantation is the best option in suitable candidates, but difficult to implement in all patients due to the poor prognosis of many patients. Pharmacological therapies based on the use of vasoconstrictor drugs plus intravenous albumins are the standard first line of therapy. Other treatments such as transjugular intrahepatic portosystemic shunts and renal replacement may be effective but experience is limited. HRS prophylaxisis recommended in patients with spontaneous bacterial peritonitis, advanced cirrhosis and those with severe acute alcoholic hepatitis. [ABSTRACT FROM AUTHOR]