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Abstract Details
Hepatorenal Syndrome: Pathophysiology and evidence-based management update
Rom J Intern Med. 2021 Jan 29. doi: 10.2478/rjim-2021-0006. Online ahead of print.
1Department of Medicine, Division of Nephrology, University of Florida College of Medicine, Jacksonville, FL.
2Department of Medicine, Mayo Clinic, Jacksonville, FL.
3The University of Texas School of Public Health, Houston, TX.
4Department of Medicine, Division of Gastroenterology, University of Florida College of Medicine, Jacksonville, FL.
5Department of Transplant, Mayo Clinic, Jacksonville, FL.
Abstract
Hepatorenal syndrome (HRS) is a functional renal failure that develops in patients with advanced hepatic cirrhosis with ascites and in those with fulminant hepatic failure. The prevalence of HRS varies among studies but in general it is the third most common cause of acute kidney injury (AKI) in cirrhotic patients after pre-renal azotemia and acute tubular necrosis. HRS carries a grim prognosis with a mortality rate approaching 90% 3 month after disease diagnosis. Fortunately, different strategies have been proven to be successful in preventing HRS. Although treatment options are available, they are not universally effective in restoring renal function but they might prolong survival long enough for liver transplantation, which is the ultimate treatment. Much has been learned in the last 2 decades regarding the pathophysiology and management of this disease which lead to notable evolution in the HRS definition and better understanding on how best to manage HRS patients. In the current review, we will summarize the recent advancement in epidemiology, pathophysiology and management of HRS.