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Hepatorenal Syndrome

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Management of Acute Kidney Problems

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Abstract

The hepatorenal syndrome (HRS) is a functional renal failure characterized by renal vasoconstriction in a patient who has advanced acute or chronic liver disease. The diagnosis of HRS is one of exclusion. New diagnostic criteria were published in 2007 by the International Ascites Club. Once established, the prognosis for hepatorenal syndrome is extremely poor. Therefore, the prevention of HRS should be an important goal in patients with advanced cirrhosis and ascites. Treatment strategies in established HRS may be only successful in the early course of the disease. For most patients liver transplant is the only causative therapy. Therefore, all patients developing HRS should be checked for suitability for a liver transplant. The application of vasoconstrictors is the treatment of choice in HRS. Although terlipressin is the standard of care, norepinephrine and midodrine are possible alternatives. Transjugular intrahepatic portosystemic shunt may be a therapeutic option in selected patients. However, contraindications of the procedure must be considered, which excludes a significant proportion of patients. Renal replacement therapy should be initiated in patients with HRS according to the common guidelines for renal failure. Although the results of pilot studies are promising, there is not enough evidence to recommend extracorporeal liver therapy as a standard procedure in patients with HRS.

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Authors and Affiliations

  1. Nephrology & Medical Intensive Care, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, 13353, Berlin, Germany

    Dietrich Hasper

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  1. Dietrich Hasper
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  2. Thomas Berg
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Correspondence to Dietrich Hasper .

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Editors and Affiliations

  1. Charité Campus Virchow, Universitätsklinikum Berlin, Augustenburger Platz 1, Berlin, 13353, Germany

    Achim Jörres

  2. Dipto. Nefrologia, Ospedale San Bortolo, Viale Rodolfi 16, Vicenza, 36100, Italy

    Claudio Ronco

  3. School of Medicine, University of Pittsburgh, Terrace Street 3550, Pittsburgh, 15261, U.S.A.

    John A. Kellum

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Hasper, D., Berg, T. (2010). Hepatorenal Syndrome. In: Jörres, A., Ronco, C., Kellum, J. (eds) Management of Acute Kidney Problems. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-69441-0_31

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  • DOI: https://doi.org/10.1007/978-3-540-69441-0_31

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