Hepatorenal Syndrome: A Mini Review: Hepatorenal Syndrome

Atilla Bulur

doi:10.5281/zenodo.7772708

Authors

Atilla Bulur Private Gastroenterology and Endoscopy Clinic Nazilli, Aydın, Turkey https://orcid.org/0000-0001-8089-7740

DOI:

https://doi.org/10.5281/zenodo.7772708

Keywords:

Hepatorenal Syndrome, cirrhosis, kidney failure

Abstract

Hepatorenal syndrome (HRS) is diagnosed in individuals who have no etiologic factors for the development of renal disease other than chronic decompensated liver disease (DLD). HRS represents the end stage of a series of reductions in renal blood flow caused by progressive severe liver injury. HRS is a strong indicator of morbidity and mortality in these patients. A specific treatment approach for HRS is not available because the mechanisms underlying the development of renal dysfunction are not clear. Because of the severe circulatory abnormality and portal hypertension in the background of the clinical aspect, HRS is the most life-threatening entity in DLD patients with acute renal dysfunction.

References

Ng CK, Chan MH, Tai MH, Lam CW. Hepatorenal syndrome. Clin Biochem Rev. 2007;28(1):11-17.

Frerichs FT. Tratado practico de las Enfermedades del Higado, de los Vasos Hepaticos y de las Vias Biliares. Madrid: Libreria Extranjera y Nacional, cientifíca y Literaria,

Flint A. Clinical report on hydro-peritoneum based on an analysis of forty-six cases. Am J Med Sci. 1863;45:306–39.

Hecker R, Sherlock S. Electrolyte and circulatory changes in terminal liver failure. Lancet. 1956;271(6953):1121-1125. doi:10.1016/s0140-6736(56)90149-0

Arroyo V, Ginès P, Gerbes AL, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology. 1996;23(1):164-176. doi:10.1002/hep.510230122

Ginès P, Schrier RW. Renal failure in cirrhosis [published correction appears in N Engl J Med. 2011 Jan 27;364(4):389]. N Engl J Med. 2009;361(13):1279-1290. doi:10.1056/NEJMra0809139

Wadei HM, Mai ML, Ahsan N, Gonwa TA. Hepatorenal syndrome: pathophysiology and management. Clin J Am Soc Nephrol. 2006;1(5):1066-1079. doi:10.2215/CJN.01340406

Ginès P, Guevara M, Arroyo V, Rodés J. Hepatorenal syndrome. Lancet. 2003;362(9398):1819-1827. doi:10.1016/S0140-6736(03)14903-3

Martin PY, Ginès P, Schrier RW. Nitric oxide as a mediator of hemodynamic abnormalities and sodium and water retention in cirrhosis. N Engl J Med. 1998;339(8):533-541. doi:10.1056/NEJM199808203390807

Iwakiri Y. The molecules: mechanisms of arterial vasodilatation observed in the splanchnic and systemic circulation in portal hypertension. J Clin Gastroenterol. 2007;41 Suppl 3:S288-S294. doi:10.1097/MCG.0b013e3181468b4c

Fernandez-Seara J, Prieto J, Quiroga J, et al. Systemic and regional hemodynamics in patients with liver cirrhosis and ascites with and without functional renal failure. Gastroenterology. 1989;97(5):1304-1312. doi:10.1016/0016-5085(89)91704-6

Ginès A, Escorsell A, Ginès P, et al. Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gastroenterology. 1993;105(1):229-236. doi:10.1016/0016-5085(93)90031-7

Runyon BA, Squier S, Borzio M. Translocation of gut bacteria in rats with cirrhosis to mesenteric lymph nodes partially explains the pathogenesis of spontaneous bacterial peritonitis. J Hepatol. 1994;21(5):792-796. doi:10.1016/s0168-8278(94)80241-6

Wiest R, Das S, Cadelina G, Garcia-Tsao G, Milstien S, Groszmann RJ. Bacterial translocation in cirrhotic rats stimulates eNOS-derived NO production and impairs mesenteric vascular contractility. J Clin Invest. 1999;104(9):1223-1233. doi:10.1172/JCI7458

Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74(2):1014-1048. doi:10.1002/hep.31884

Sherman DS, Fish DN, Teitelbaum I. Assessing renal function in cirrhotic patients: problems and pitfalls. Am J Kidney Dis. 2003;41(2):269-278. doi:10.1053/ajkd.2003.50035

Caregaro L, Menon F, Angeli P, et al. Limitations of serum creatinine level and creatinine clearance as filtration markers in cirrhosis. Arch Intern Med. 1994;154(2):201-205

SSalerno F, Gerbes A, Ginès P, Wong F, Arroyo V. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Gut. 2007;56(9):1310-1318. doi:10.1136/gut.2006.107789

Sort P, Navasa M, Arroyo V, 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(6):403-409. doi:10.1056/NEJM199908053410603

Angeli P, Fasolato S, Mazza E, et al. Combined versus sequential diuretic treatment of ascites in non-azotaemic patients with cirrhosis: results of an open randomised clinical trial. Gut. 2010;59(1):98-104. doi:10.1136/gut.2008.176495

Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P; Acute Dialysis Quality Initiative workgroup. Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8(4):R204-R212. doi:10.1186/cc2872

Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11(2):R31. doi:10.1186/cc5713

Stevens PE, Levin A; Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158(11):825-830. doi:10.7326/0003-4819-158-11-201306040-00007)

Martín-Llahí M, Guevara M, Torre A, et al. Prognostic importance of the cause of renal failure in patients with cirrhosis. Gastroenterology. 2011;140(2):488-496.e4. doi:10.1053/j.gastro.2010.07.043

Laffi G, Daskalopoulos G, Kronborg I, Hsueh W, Gentilini P, Zipser RD. Effects of sulindac and ibuprofen in patients with cirrhosis and ascites. An explanation for the renal-sparing effect of sulindac. Gastroenterology. 1986;90(1):182-187. doi:10.1016/0016-5085(86)90091-0

de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C; Baveno VII Faculty. Baveno VII - Renewing consensus in portal hypertension [published correction appears in J Hepatol. 2022 Apr 14;:]. J Hepatol. 2022;76(4):959-974. doi:10.1016/j.jhep.2021.12.022

Amini M, Runyon BA. Alcoholic hepatitis 2010: a clinician’s guide to diagnosis and therapy. World J Gastroenterol. 2010;16(39):4905-4912. doi:10.3748/wjg.v16.i39.4905

Garg H, Sarin SK, Kumar M, Garg V, Sharma BC, Kumar A. Tenofovir improves the outcome in patients with spontaneous reactivation of hepatitis B presenting as acute-on-chronic liver failure [published correction appears in Hepatology. 2011 Sep 2;54(3):1114]. Hepatology. 2011;53(3):774-780. doi:10.1002/hep.24109

Piano S, Tonon M, Angeli P. Management of ascites and hepatorenal syndrome. Hepatol Int. 2018;12(Suppl 1):122-134. doi:10.1007/s12072-017-9815-0

Guevara M, Ginès P, Fernández-Esparrach G, et al. Reversibility of hepatorenal syndrome by prolonged administration of ornipressin and plasma volume expansion. Hepatology. 1998;27(1):35-41. doi:10.1002/hep.510270107

Cardenas A, Gines P. Pathogenesis and treatment of dilutional hyponatraemia in cirrhosis. In: Arroyo V, Forns X, Garcia-Pagan JC, Rodes J, editors. Progress in the treatment of liver diseases. Barcelona: Ars Medica, 2003. p. 31–42.

Rössle M, Gerbes AL. TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax: a critical update. Gut. 2010;59(7):988-1000. doi:10.1136/gut.2009.193227

Allegretti AS, Parada XV, Eneanya ND, et al. Prognosis of Patients with Cirrhosis and AKI Who Initiate RRT. Clin J Am Soc Nephrol. 2018;13(1):16-25. doi:10.2215/CJN.03610417

Wong LP, Blackley MP, Andreoni KA, Chin H, Falk RJ, Klemmer PJ. Survival of liver transplant candidates with acute renal failure receiving renal replacement therapy. Kidney Int. 2005;68(1):362-370. doi:10.1111/j.1523-1755.2005.00408.x

Velez JC, Nietert PJ. Therapeutic response to vasoconstrictors in hepatorenal syndrome parallels increase in mean arterial pressure: a pooled analysis of clinical trials. Am J Kidney Dis. 2011;58(6):928-938. doi:10.1053/j.ajkd.2011.07.017

Arroyo V, Guevara M, Ginès P. Hepatorenal syndrome in cirrhosis: pathogenesis and treatment. Gastroenterology. 2002;122(6):1658-1676. doi:10.1053/gast.2002.33575

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(2):428-430. doi:10.1097/00007890-199102000-00030

European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu. EASL Clinical Practice Guidelines: Liver transplantation. J Hepatol. 2016;64(2):433-485. doi:10.1016/j.jhep.2015.10.006

Bulur A, Sevmiş M. Clinical, surgical and histopathological characteristics of liver transplant recipients: An analysis of a large sample from Turkey. Gulhane Med J. 2022; 64:60-6. doi: 10.4274/gulhane.galenos.2021.83803

Wong F, Leung W, Al Beshir M, Marquez M, Renner EL. Outcomes of patients with cirrhosis and hepatorenal syndrome type 1 treated with liver transplantation. Liver Transpl. 2015;21(3):300-307. doi:10.1002/lt.24049

Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O. Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial. Gastroenterology. 2000;119(6):1637-1648. doi:10.1053/gast.2000.20189

LLinas SL, Schaefer JW, Moore EE, Good JT Jr, Giansiracusa R. Peritoneovenous shunt in the management of the hepatorenal syndrome. Kidney Int. 1986;30(5):736-740. doi:10.1038/ki.1986.249

Alessandria C, Ozdogan O, Guevara M, et al. MELD score and clinical type predict prognosis in hepatorenal syndrome: relevance to liver transplantation. Hepatology. 2005;41(6):1282-1289. doi:10.1002/hep.20687

Restuccia T, Ortega R, Guevara M, et al. Effects of treatment of hepatorenal syndrome before transplantation on posttransplantation outcome. A case-control study. J Hepatol. 2004;40(1):140-146. doi:10.1016/j.jhep.2003.09.019

Tonon M, Rosi S, Gambino CG, et al. Natural history of acute kidney disease in patients with cirrhosis. J Hepatol. 2021;74(3):578-583. doi:10.1016/j.jhep.2020.08.037

Hepatorenal Syndrome: A Mini Review