Hepatorenal syndrome (HRS) is a common complication of advanced
cirrhosis, characterized by
renal failure and major abnormalities in the systemic circulatory function.
Renal failure is caused by intense vasoconstriction of the renal circulation. The syndrome is probably the final consequence of an extreme underfilling of the arterial circulation, secondary to vasodilatation in the splanchninc vascular bed and a decrease in cardiac output due to central
hypovolemia. The diagnosis of HRS is based on the exclusion of other causes of
renal failure. The survival of patients with HRS is very short, particularly when there is rapidly progressive
renal failure (type-1 HRS).
Liver transplantation is the best therapeutic option but its applicability is low. During the past few years effective treatment for HRS, such as
vasoconstrictor drugs (
vasopressin analogues, proportional variant-
adrenergic agonists) associated with intravenous
albumin infusion and transjugular intrahepatic
portosystemic shunts (
TIPS), have been introduced. They improve circulatory function, normalize serum
creatinine, and may improve survival. Sequential treatment with
vasoconstrictors plus
albumin and
TIPS is an attractive therapeutic possibility. Plasma volume expansion with
albumin at
infection diagnosis in patients with spontaneous bacterial
peritonitis and the administration of pentoxiphilline in patients with severe
alcoholic hepatitis significantly reduce the development of type-1 HRS.