Renal dysfunction occurs frequently in hospitalized patients with advanced chronic
liver disease (ACLD)/
cirrhosis and has profound prognostic implications. In ACLD patients with
ascites,
hepatorenal syndrome (HRS) may result from circulatory dysfunction that leads to reduced kidney perfusion and glomerular filtration rate (in the absence of structural kidney damage). The traditional subclassification of HRS has recently been replaced by
acute kidney injury (AKI) type of HRS (HRS-AKI) and non-AKI type of HRS (HRS-NAKI), replacing the terms "HRS type 1" and "HRS type 2", respectively. Importantly, the concept of absolute serum
creatinine (sCr) cutoffs for diagnosing HRS was partly abandoned and short term sCr dynamics now may suffice for AKI diagnosis, which facilitates early treatment initiation that may prevent the progression to HRS-AKI or increase the chances of AKI/HRS-AKI reversal. Recent randomized controlled trials have established (a) the efficacy of (long-term)
albumin in the prevention of complications of
ascites (including HRS-AKI), (b) the benefits of transjugular intrahepatic
portosystemic shunt placement in patients with recurrent
ascites, and (c) the superiority of
terlipressin over
noradrenaline for the treatment of HRS-AKI in the context of
acute-on-chronic liver failure. This review article aims to summarize recent advances in the understanding and management of HRS.