Hepatorenal Syndrome in Cirrhosis.
Hepatorenal syndrome (HRS) is a distinctive form of kidney dysfunction in advanced liver cirrhosis; it has been reclassified into an acute form (HRS-AKI) and a chronic form, and is treated with vasoconstrictors plus albumin, with liver or combined liver-kidney transplantation the only definitive cure despite a poor prognosis.
Background
Hepatorenal syndrome is a form of kidney dysfunction that characteristically occurs in liver cirrhosis. It results from circulatory and hemodynamic alterations of advanced cirrhosis, aggravated by systemic inflammation and bacterial translocation. The classical definitions have been revisited, redefining two forms: an acute form referred to as acute kidney injury (HRS-AKI) and a chronic form referred to as chronic kidney disease.
Diagnosis
HRS-AKI is one of the most severe forms of AKI in patients with cirrhosis, consisting of an abrupt impairment of kidney function that is frequently triggered by infection in the setting of advanced decompensated cirrhosis. Differential diagnosis with other causes of AKI is crucial because HRS-AKI requires specific treatment; distinguishing it from acute tubular necrosis may be challenging, and kidney biomarkers may be useful in this setting.
Clinical implications
Treatment of HRS-AKI is based on vasoconstrictor drugs combined with volume expansion using albumin. The prognosis is poor, and the ideal definitive treatment is liver transplantation or simultaneous liver-kidney transplantation. Management remains challenging in specific situations such as alcohol-associated hepatitis or metabolic-associated steatotic liver disease cirrhosis. Unmet needs include preventive measures, earlier identification, better biomarkers for differential diagnosis, and improved treatment response.
Category
Research
Source
Gastroenterology
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