Hepatorenal Syndrome
1. Hepatorenal syndrome (HRS) is a form of functional acute kidney injury (AKI), which occurs in patients with end-stage liver cirrhosis and circulatory dysfunction.
2. The circulatory dysfunction of end-stage cirrhosis leads to a reduction in effective arterial blood volume, which stimulates renal vasoconstriction via the various systemic vasoconstrictor systems, predisposing patients to kidney failure.
3. Any condition that causes a further reduction of the effective arterial blood volume can potentially precipitate AKI-HRS. These include sepsis, over-diuresis, large-volume paracentesis (≥5 liters) without intravascular volume replacement, and gastrointestinal bleeding.
4. In hospitalized patients with cirrhosis, prerenal azotemia is the most common cause of acute kidney injury. HRS can be considered a form of prerenal azotemia, which is not volume responsive and which is seen exclusively in patients with severe liver dysfunction.
5. Type 1 HRS has been renamed AKI-HRS.
6. Pharmacologic treatment (e.g., midodrine and octreotide, terlipressin, norepinephrine) increases survival, but the only definitive treatment is liver transplantation.
Hepatorenal syndrome (HRS) is a serious and potentially life-threatening complication of advanced liver disease, primarily cirrhosis. It’s characterized by the sudden and severe deterioration of kidney function in individuals with liver cirrhosis and portal hypertension. HRS typically occurs when the liver’s ability to function is severely impaired, leading to changes in blood flow and pressure within the liver and the circulatory system. This can result in kidney dysfunction.
There are two main types of hepatorenal syndrome:
- HRS Type 1: This is the more severe form of HRS and is characterized by a rapid and significant decline in kidney function. It often develops as a result of a precipitating event, such as a severe infection, bleeding in the digestive tract, or other stressors on the body. HRS type 1 has a very poor prognosis and requires prompt medical attention.
- HRS Type 2: HRS type 2 is less severe and progresses more slowly. It is usually associated with more stable liver function compared to HRS type 1. While it still requires medical attention, the prognosis is generally better, and kidney function can sometimes improve with treatment.
The exact cause of HRS is not fully understood, but it is believed to be related to changes in blood flow within the liver and the release of vasoactive substances. The syndrome is typically diagnosed based on clinical and laboratory criteria, including elevated creatinine levels, low urine output, and exclusion of other possible causes of kidney dysfunction.
Treatment for HRS is aimed at addressing the underlying liver disease and improving kidney function. It often involves a combination of medical interventions, including vasoconstrictor drugs (to increase blood flow to the kidneys), albumin infusions, and other supportive measures. In some cases, liver transplantation may be necessary, as it can provide the best chance for long-term survival.
HRS is a serious condition, and its prognosis varies depending on the type and the patient’s overall health. Prompt diagnosis and treatment are crucial in managing HRS, especially in the case of HRS type 1, which can progress rapidly and be life-threatening. If you or someone you know has liver disease and experiences symptoms of kidney dysfunction, it’s important to seek immediate medical attention.
