ABSTRACT
Cirrhosis is the eighth leading cause of "years of lost life" in the United States and accounts for approximately 1% to 2% of all deaths in Europe. Patients with cirrhosis have a high risk of developing acute kidney injury. The clinical characteristics of hepatorenal syndrome (HRS) are similar to prerenal uremia, but the condition does not respond to volume expansion. HRS type 1 is rapidly progressive whereas HRS type 2 has a slower course often associated with refractory ascites. A number of factors can precipitate HRS such as infections, alcoholic hepatitis, and bleeding. The monitoring, prevention, early detection, and treatment of HRS are essential. This paper reviews the value of early evaluation of renal function based on two new sets of diagnostic criteria. Interventions for HRS type 1 include terlipressin combined with albumin. In HRS type 2, transjugular intrahepatic portosystemic shunt (TIPS) should be considered. For both types of HRS patients should be evaluated for liver transplantation.
Subject(s)
Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Hepatorenal Syndrome/etiology , Hepatorenal Syndrome/therapy , Liver Cirrhosis/complications , Acute Kidney Injury/classification , Acute Kidney Injury/diagnosis , Albumins/administration & dosage , Ascites/etiology , Disease Progression , Drug Therapy, Combination , Early Diagnosis , Hepatorenal Syndrome/classification , Hepatorenal Syndrome/diagnosis , Humans , Liver Transplantation , Lypressin/administration & dosage , Lypressin/analogs & derivatives , Portasystemic Shunt, Transjugular Intrahepatic , TerlipressinABSTRACT
Cirrhosis, ascites and renal impairment are associated with high morbidity and mortality. The hepatorenal syndrome (HRS) is a type of renal failure that affects patients with cirrhosis and ascites. This paper provides an update on evidence-based interventions in HRS. A number of factors can precipitate HRS. The monitoring, prevention, early detection, and correct treatment of these are essential. Terlipressin combined with albumin is the first-line treatment of type 1 HRS. In type 2 HRS with refractory ascites, liver transplantation and TIPS should be considered.
