Hepatorenal syndrome

Hepatorenal syndrome (HRS) is associated with acute liver failure including cirrhosis.

HRS is diagnosed by excluding other causes of renal failure.

Liver transplantation is the only definitive treatment.

Dialysis and transjugular intrahepatic portosystemic shunts are temporizing measures while awaiting liver transplantation.

The vasopressin analog terlipressin is very effective at reversing the condition in some patients, but its benefits need to be weighed against the risk of respiratory failure and sepsis.

General prognosis is poor.

Hepatorenal syndrome (HRS) is a type of acute kidney injury in patients with acute or chronic liver disease. HRS occurs in the absence of hypovolemia or significant abnormalities in kidney histology.[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