Recent Advances in the Treatment of Renal Dysfunction in Liver Disease (Hepatorenal Syndrome)

Abstract

A large body of information is available concerning the effects on the kidney of a diseased liver. The most grave expression of this interrelationship is the hepatorenal syndrome (HRS) (1, 2). The HRS is a form of unexplained acute renal failure occurring in patients with parenchymal end-stage or acute liver disease of diverse etiology in the absence of clinical, laboratory, or anatomic evidence of other known causes of renal failure. The relative frequency of different types of liver disease causing HRS, depends on geographic and other unknown factors. In the U.S.A. the most common cause of HRS is alcoholic liver disease (Laennec’s cirrhosis), whereas in other countries in addition to an alcoholic etiology, postnecrotic, cryptogenic cirrhosis or fulminant acute hepatic failure are also frequently reported. The occurrence of the HRS is distinctly rare in children (3). Terms such as “renal failure of cirrhosis”, “functional renal failure”, “cirrhotic nephropathy”, and others, have been used from time to time to identify this specific renal dysfunction of liver disease. Not having any desire to add to the controversy related to terminology, I will use in this review the more appealing and common term HRS. A comprehensive review of the clinical aspects and pathogenesis of the HRS can be found elsewhere (1, 2, 4). In this review, the emphasis will be on the treatment of this serious condition.