An Integrated Review of the Hepatorenal Syndrome.

Alicia S Ojeda-Yuren, Eira Cerda-Reyes, Maria R Herrero-Maceda, Graciela Castro-Narro, Salvatore Piano

Journal: Annals of hepatology 2021;22():100236

PMID: 32846202

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Abstract

Among the complications of cirrhosis, hepatorenal syndrome (HRS) is characterized by having the worst survival rate. HRS is a disorder that involves the deterioration of kidney function caused primarily by a systemic circulatory dysfunction, but in recent years, systemic inflammation and cirrhotic cardiomyopathy have been discovered to also play an important role. The diagnosis of HRS requires to meet the new International Club of Ascites-Acute Kidney Injury (ICA-AKI) and Hepatorenal Syndrome-Acute Kidney Injury (HRS-AKI) criteria after ruling out other causes of kidney injury. At the time of diagnosis, it is important to start the medical treatment as soon as possible where three types of vasoconstrictors have been recognized: vasopressin analogs (ornipressin and terlipressin), alpha-adrenergic agonists (norepinephrine and midodrine) and somatostatin analogues (octreotide); all should be combined with albumin infusion. Among them, terlipressin and albumin are the first lines of treatment in most cases, although terlipressin should be monitor closely due to its adverse events. The best treatment of choice is a liver transplant, because it is the only definitive treatment for this disease.

Address: Gastroenterology Section, Central Military Hospital, Ring Road, Blvrd. Manuel Avila Camacho, Militar, Miguel Hidalgo, 11200 Mexico City, Mexico. Electronic address: [email protected].; Gastroenterology Section, Central Military Hospital, Ring Road, Blvrd. Manuel Avila Camacho, Militar, Miguel Hidalgo, 11200 Mexico City, Mexico; Army and Air Force University of Mexico, Gastroenterology Specialization Course of the Military School of Health Graduates, Batalla de Celaya 202, Lomas of Sotelo, Militar, Miguel Hidalgo, 11200 Mexico City, Mexico. Electronic address: [email protected].; Gastroenterology Section, Central Military Hospital, Ring Road, Blvrd. Manuel Avila Camacho, Militar, Miguel Hidalgo, 11200 Mexico City, Mexico; Army and Air Force University of Mexico, Gastroenterology Specialization Course of the Military School of Health Graduates, Batalla de Celaya 202, Lomas of Sotelo, Militar, Miguel Hidalgo, 11200 Mexico City, Mexico. Electronic address: [email protected].; Gastroenterology Department, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Vasco of Quiroga 15, Belisario Domínguez Secc 16, Tlalpan, 14080 Mexico City, Mexico. Electronic address: [email protected].; Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine - DIMED, University of Padua, Via 8 Febbraio 1848, 2, 35122 Padova, PD, Italy. Electronic address: [email protected].

DOI: 10.1016/j.aohep.2020.07.008