Hepatorenal syndrome

Hepatorenal syndrome (HRS) is a complication of portal hypertension in the setting of advanced liver disease.

HRS is diagnosed when kidney function is reduced but evidence of intrinsic kidney disease is absent.

HRS is classified as HRS-acute kidney injury (HRS-AKI) or HRS-NAKI (i.e., non-AKI). HRS-NAKI is further divided into HRS-acute kidney disease (HRS-AKD; estimated glomerular filtration rate <60 mL/min/1.73 m² for <3 months) and HRS-chronic kidney disease (HRS-CKD; estimated glomerular filtration rate <60 mL/min/1.73 m² for ≥3 months).

Management of HRS-AKI includes administration of vasoconstrictor drugs plus volume expansion with albumin. However, the definitive treatment of HRS is either liver transplantation or simultaneous liver-kidney transplantation. Renal replacement therapy is considered a temporising measure while awaiting liver transplantation.

General prognosis is poor.

Hepatorenal syndrome (HRS) is a type of kidney injury or disease in patients with portal hypertension resulting from acute or chronic liver disease. HRS occurs in the absence of hypovolaemia or significant structural kidney abnormalities.[1]Dagher L, Moore K. The hepatorenal syndrome. Gut. 2001 Nov;49(5):729-37. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1728492/pdf/v049p00729.pdf http://www.ncbi.nlm.nih.gov/pubmed/11600480?tool=bestpractice.com [2]Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021 Aug;74(2):1014-48. https://aasldpubs.onlinelibrary.wiley.com/doi/10.1002/hep.31884 http://www.ncbi.nlm.nih.gov/pubmed/33942342?tool=bestpractice.com