Hepatorenal Syndrome: A Cause of Kidney Failure in Cirrhosis
Hepatorenal Syndrome: A Cause of Kidney Failure in Cirrhosis
Investigations performed in the late 1950s to early 1970s provided conclusive evidence indicating that HRS is a unique form of kidney failure that occurs in patients with cirrhosis and is due to marked vasoconstriction of the renal circulation. Since then, it has become evident that the kidney failure of HRS is of circulatory origin. An extremely dilated splanchnic arterial bed triggers a marked disturbance in the systemic circulation, ultimately leading to kidney failure due to vasoconstriction of the kidney arteries. Although once considered an irreversible and untreatable condition (except for liver transplant), studies performed within the past decade have shown that HRS may be reversible with pharmacologic treatment. This review provides an overview of the pathogenesis, clinical findings, differential diagnosis, and management of HRS, with particular emphasis on pharmacologic treatment.
Introduction
Investigations performed in the late 1950s to early 1970s provided conclusive evidence indicating that HRS is a unique form of kidney failure that occurs in patients with cirrhosis and is due to marked vasoconstriction of the renal circulation. Since then, it has become evident that the kidney failure of HRS is of circulatory origin. An extremely dilated splanchnic arterial bed triggers a marked disturbance in the systemic circulation, ultimately leading to kidney failure due to vasoconstriction of the kidney arteries. Although once considered an irreversible and untreatable condition (except for liver transplant), studies performed within the past decade have shown that HRS may be reversible with pharmacologic treatment. This review provides an overview of the pathogenesis, clinical findings, differential diagnosis, and management of HRS, with particular emphasis on pharmacologic treatment.