Hepato-renal Syndrome: Etiopathogenesis, Diagnosis and Treatment

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ABSTRACT

Hepatorenal syndrome (HRS) involves reversible renal failure in patients with advanced cirrhosis or acute liver failure. The aim of the study was to determine the pathogenetic mechanisms of the development of hepatorenal syndrome and to emphasise the clinical importance of early detection and timely treatment of patients with this condition. Th e one-year incidence rate of hepatorenal syndrome in patients with liver cirrhosis is 18-20%. Th e risk factors for the development of hepatorenal syndrome include the following: spontaneous bacterial peritonitis, gastrointestinal bleeding, nephrotoxic drugs, diuretics, non-steroidal anti-inflammatory drugs, and hyponatraemia. The primary plan of treatment is a liver transplantation, while a secondary plan of treatment is the use of a vasoconstrictor in conjunction with albumin. Early diagnosis and prompt appropriate treatment can significantly reduce the mortality rate of patients with hepatorenal syndrome.

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  • 1. Dagher L Moore K. The hepatorenal syndrome. Gut 2001;49(5): 729-37.

  • 2. Arroyo V Torre A Guevara M. Recent advances in hepatorenal syndrome. Trop Gastroenterol 2005; 26(1): 13-20.

  • 3. Barada K. Hepatorenal syndrome: pathogenesis and novel pharmacological targets. Curr Opin Pharmacol 2004; 4(2):189-97.

  • 4. Arroyo V Guevara M Gines P. Hepatorenal syndrome in cirrhosis: pathogenesis and treatment. Gastroenterology 2002; 122(6): 1658-76.

  • 5. Blaise P Moonen M Rorive G. Update on hepatorenal syndrome. Nephrologie 2002; 23(1): 11-7. (French)

  • 6. Kramer L Horl WH. Hepatorenal syndrome. Semin Nephrol 2002; 22(4): 290-301.

  • 7. Biswas KD Jain AK. Hepatorenal syndrome. Review.Tropical Gastroenterology 2002; 23(3):113-6.

  • 8. Gentilini P Vizzutti F Gentilini A Zipoli M Foschi M Romanelli RG. Update on ascites and hepatorenal syndrome. Review. Digestive & Liver Disease 2002; 34(8):592-605.

  • 9. Arroyo V Gines P Gerbes AL Dudley FJ Gentilini P Laffi G. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology 1996; 23:164-76.

  • 10. Gines A Escorsell A Gines P Salo J Jimenez W Inglada L Navasa M Claria J Rimola A Arroyo V. Incidence predictive factors and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gastroenterology. 1993;105:229-236.

  • 11. Garcia-Tsao G Parikh CR Viola A: Acute kidney injury in cirrhosis. Hepatology 2008; 48: 2064-2077.

  • 12. Gines P Guevara M Arroyo V Rodes J. Hepatorenal syndrome. Lancet 2003; 362(9398): 1819-27.

  • 13. Cholongitas E Senzolo M Patch D Shaw S O’Beirne J Burroughs AK: Cirrhotics admitted to intensive care unit: the impact of acute renal failure on mortality. Eur J Gastroenterol Hepatol 2009; 21: 744-750.

  • 14. Gines P: Pharmacological management of hepatorenal syndrome: lessons from non-responders. J Hepatol 2011; 55: 268-269.

  • 15. Gluud LL Christensen K Christensen E Krag A: Systematic review of randomized trials on vasoconstrictor drugs for hepatorenal syndrome. Hepatology 2010; 51: 576-584.

  • 16. Petrović D.Hepato-renalni sindrom: etiopatogeneza dijagnostika I lečenje. U: Akutno oštećenje bubrega u kliničkoj praksi. Petrović D.Ed.Kragujevac:Interprint 2013:277-84

  • 17. Salerno F Gerbes A Gines P Wong F Arroyo V: Diagnosis prevention and treatment of hepatorenal syndrome in cirrhosis. Gut 2007;56: 1310-1318.

  • 18. Alessandria C Ozdogan O Guevara M Restuccia T Jimenez W Arroyo V Rodes J Gines P: Meld score and clinical type predict prognosis in hepatorenal syndrome: relevance to liver transplantation. Hepatology 2005; 41: 1282-1289.

  • 19. Moreau R Lebrec D. Acute renal failure in patients with cirrhosis: perspectives in the age of MELD. Hepatology. 2003;16:233-243.

  • 20. Angeli P Morando F Cavallin M Piano S. Hepatorenal syndrome. Contrib Nephrol. 2011;174:46-55.

  • 21. Cardenas A Gines P Rodes J. Renal complications. In: Schiff ER Sorrekk MF Maddrey WC editors. Schiff ’s Diseases of the Liver. Philadelphia: Lippincott Williams & Wilkins: A Wolters Kluwer Company; 2003. p.497-509

  • 22. Petrović D.Akutno oštećenje bubrega; etiologija dijagnostika i lečenje. Medicinska istraživanja 2011; 45(3):7-13

  • 23. Nadim MK Kellum JA Davenport A Wong F Davis C Pannu N Tolwani A Bellomo R Genyk Y. Hepatorenal syndrome: the 8th International Consensus Conference of the Acute Dialysis Quality Initiative Group. Crit Care. 2012;16:R23.

  • 24. Gines P Schrier RW. Renal failure in cirrhosis. N Engl J Med. 2009;16:1279-1290.

  • 25. Angeli P Wong F Watson H. Hyponatremia in cirrhosis: results of a patient population survey. Hepatology. 2006;44:1535-1542.

  • 26. Sherlock S Dooley J. Ascites. In: Sherlock S Dooley J editors. Diseases of the Liver and Biliary System. 11th ed. Oxford UK: Blackwell Publishing Company; 2002. p.127-46.

  • 27. Gines P Berl T Bernardi M. Hyponatremia in cirrhosis: from pathogenesis to treatment. Hepatology. 1998;28:851-864

  • 28. Amodio P Del Piccolo F Petteno E. Prevalence and prognostic value of quantified electroencephalogram alterations in cirrhotic patients. J Hepatol. 2001;35:37-45.

  • 29. Heuman DM Abou-Assi SG Habib A. Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at high risk for early death. Hepatology. 2004;40:802-810.

  • 30. Konstam MA Ghiorghiade M Burnett JC Jr. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST Outcome Trial. LAMA 2007;297:1319-1331.

  • 31. Sort P Navasa M Arroyo V Aldeguer X Planas R Ruiz del Arbol L et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med 1999;341:403-409.

  • 32. Fasolato S Angeli P Dallagnese L Maresio G Zola E Mazza E et al. Renal failure and bacterial infections in patients with cirrhosis: epidemiology and clinical features.Hepatology 2007;45:223-229.

  • 33. Lukić S Petrović D. Prevencija akutnog oštećenja bubrega u jedinicama intenzivnog lečenja. Med Čas 2012; 46(2):100-4.

  • 34. Gonwa TA Morris CA Goldstein RM Husberg BS Klintmalm GB. Long-term survival and renal function following liver transplantation in patients with and without hepatorenal syndrome - experience in 300 patients.Transplantation 1991;51:428-430.

  • 35. Lafayette RA Pare G Schmid CH King AJ Rohrer RJ Nasraway SA. Pretransplant renal dysfunction predicts poorer outcome in liver transplantation. Clin Nephrol. 1997;48:159-164.

  • 36. Gonwa TA Klintmalm GB Levy M Jennings LS Goldstein RM Husberg BS. Impact of pretransplant renal function on survival after liver transplantation. Transplantation. 1995;59:361-365.

  • 37. Schepke M Appenrodt B Heller J Zielinski J Sauerbruch T. Prognostic factors for patients with cirrhosis and kidney dysfunction in the era of MELD: results of a prospective study. Liver Int 2006;26:834-839.

  • 38. Olivera-Martinez M Sayles H Vivekanandan R D’ Souza S Florescu MC. Hepatorenal syndrome: are we missing some prognostic factors? Dig Dis Sci 2012 57(1):210-4.

  • 39. Le Moine O. Hepatorenal syndrome - outcome after liver transplantation. Nephrol Dial Transplant 1998; 13(1):20-2.

  • 40. Piano S Morando F Fasolato S Cavallin M Boscato N Boccagni P Zanus G Cillo U Gatta A Angeli P. Continuous recurrence of type 1 hepatorenal syndrome and long-term treatment with terlipressin and albumin: a new exception to MELD score in the allocation system to liver transplantation? J Hepatol. 2011;55:491-496.

  • 41. Caraceni P Santi L Mirici F Montanari G Bevilacqua V Pinna AD Bernardi M. Long-term treatment of hepatorenal syndrome as a bridge to liver transplantation.Dig Liver Dis. 2011;43:242-245

  • 42. Salo J Gines A Quer JC Fernandez-Esparrach G Guevara M Gines P Bataller R Planas R Jimenez W Arroyo V et al. Renal and neurohormonal changes following simultaneous administration of systemic vasoconstrictors and dopamine or prostacyclin in cirrhotic patients with hepatorenal syndrome. J Hepatol 1996;25:916-923.

  • 43. European Association for the Study of the Liver: EASL clinical practice guidelines on the management of ascites spontaneous bacterial peritonitis and hepatorenal syndrome in cirrhosis. J Hepatol 2010; 53: 397-417.

  • 44. Runyon BA: Management of adult patients with ascites due to cirrhosis: an update. Hepatology 2009; 49: 2087-2107.

  • 45. Moreau R Lebrec D. The use of vasoconstrictors in patients with cirrhosis: type 1 HRS and beyond. Hepatology 2006;43:385-394.

  • 46. Maddukuri G Cai CX Munigala S Mohammadi F Zhang Z. Targeting an Early and Substantial Increase in Mean Arterial Pressure Is Critical in the Management of Type 1 Hepatorenal Syndrome: A Combined Retrospective and Pilot Study.Dig Dis Sci 2013.

  • 47. Martin L Lahi M Pepin MN Guevara M et al. Terlipressin and albumina vs albumina in patients with cirrhosis and hepatorenal syndrome: a randomized study.Gastroenterology 2008;134:1352-1359.

  • 48. Alessandria C Venon WD Marzano A Barletti C Fadda M Rizzetto M. Renal failure in cirrhotic patients: role of terlipressin in clinical approach to hepatorenal syndrome type 2. Eur J Gastroenterol Hepatol 2002;47:401-404.

  • 49. Rajekar H Chawla Y. Terlipressin in hepatorenal syndrome: Evidence for present indications. J Gastroenterol Hepatol. 2011;26 Suppl 1:109-114.

  • 50. Wong F Pantea L Sniderman K. Midodrine octreotide albumin and TIPS in selected patients with cirrhosis and type 1 hepatorenal syndrome. Hepatology 2004;40:55-64.

  • 51. Rossle M Gerbes AL. TIPS for the treatment of refractory ascites hepatorenal syndrome and hepatic hydrothorax: a critical update. Gut 2010;59:988-1000.

  • 52. Testino G Ferro C Sumberaz A Messa P Morelli N Guadagni B Ardizzone G Valente U. Type-2 hepatorenal syndrome and refractory ascites: role of transjugular intrahepatic portosystemic stent-shunt in eighteen patients with advanced cirrhosis awaiting orthotopic liver transplantation. Hepatogastroenterology 2003;50:1753-1755.

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