HEPATORENAL SYNDROME

Matjaž Hafner

Matjaž Hafner Klinični oddelek za gastroenterologijo Klinični center Japljeva ul. 2 1525 Ljubljana

Keywords: advanced liver disease, arterial circulatory abnormalities, renal failure, diagnostic criteria, liver transplantation

Abstract

Background. Hepatorenal syndrome (HRS) is a

common complication of advanced hepatic disease characterized

by marked abnormalities in arterial circulation and by

renal failure. An extreme arteriolar vasodilatation located in

the splanchnic circulation results in a reduction of total systemic

vascular resistence and arterial hypotension. Vasoconstriction

occurs in the renal circulation as in all other extrasplanchnic

vascular territories. In the kidney, marked renal

vasoconstriction results in a low glomerular filtration rate.

Conclusions. The diagnosis of HRS is currently based on exclusion

of other causes of renal failure. Prognosis of patients

with HRS is very poor. Liver transplantation is the best therapeutic

option, but it is seldom applicable due to the short survival

expectancy of most patients with HRS, particularly those

with the rapidly progressive type of HRS. New therapies developed

during the last few years, such as the use of systemic

vasoconstrictors or transjugular intrahepatic portosystemic

shunts (TIPS) appear promising. Such treatments are of interest

not only as a bridge to liver transplantation but also as a

therapy for patients who are not candidates for transplantation.

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