Hepatorenal syndrome (HRS) in cirrhotic patients with ascites
is a functional form of kidney failure with a very poor prognosis.
It is one of the numerous potential causes of acute kidney
injury (AKI) in patients with decompensated cirrhosis. The
pathophysiology of this syndrome is complex with several
mechanisms interacting simultaneously, including liver cirrhosis
with ascites, portal hypertension, arterial vasodilation, systemic
inflammation and bacterial translocation. Although different
medical modalities of treatment of HRS are available, the liver
transplantation remains the treatment of choice. The aims of
medical treatment are to stabilize the patients until liver transplantation
and to optimize their pre-transplant clinical conditions.
Most of these therapies have targeted the haemodynamic
perturbations that are thought to underlie the pathophysiology of
HRS, including systemic and splanchnic vasodilation. Other
management options, such as transjugular intrahepatic portosystemic
shunt, renal replacement therapy and molecular
absorbent recirculating system, may provide short-term benefit
for patients not responding to medical therapy whilst awaiting
transplantation. This review demonstrate the diagnostic approach
to HRS, the underlie pathophysiology events and the therapeutic
measures currently adopted in clinical practice.