Skip to main content
SpringerLink
Log in

Hepatorenal Syndrome

  • Chapter
  • First Online:
Practical Nephrology

  • 2443 Accesses

Abstract

Renal dysfunction, particularly acute kidney injury (AKI), is relatively common in patients with cirrhotic liver disease. Both prerenal and intrinsic renal causes predominate. Hepatorenal syndrome (HRS) is a specific form of prerenal failure characterised by systemic vasodilatation with renal vasoconstriction in patients with portal hypertension and cirrhotic liver disease. It can also occur with acute liver failure such as alcoholic hepatitis. Hepatorenal syndrome is often a diagnostic challenge with a complex underlying pathophysiology, but greater understanding has led to therapeutic advances over recent decades. However, it remains a serious complication signifying a poor prognosis for some, particularly those not suitable for liver transplantation (LT) [1, 2].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Gines P, Schrier RW. Renal failure in cirrhosis. N Engl J Med. 2009;361(13):1279–90.

    Article  CAS  PubMed  Google Scholar 

  2. Salerno F, Gerbes A, Gines P, Wong F, Arroyo V. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Gut. 2007;56(9):1310–8.

    CAS  PubMed Central  PubMed  Google Scholar 

  3. Arroyo V, Gines P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology. 1996;23(1):164–76.

    Article  CAS  PubMed  Google Scholar 

  4. Gonwa TA, Jennings L, Mai ML, Stark PC, Levey AS, Klintmalm GB. Estimation of glomerular filtration rates before and after orthotopic liver transplantation: evaluation of current equations. Liver Transpl. 2004;10(2):301–9.

    Article  PubMed  Google Scholar 

  5. Wong F, Nadim MK, Kellum JA, Salerno F, Bellomo R, Gerbes A, et al. Working party proposal for a revised classification system of renal dysfunction in patients with cirrhosis. Gut. 2011;60(5):702–9.

    Article  PubMed  Google Scholar 

  6. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11(2):R31.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Nadim MK, Kellum JA, Davenport A, Wong F, Davis C, Pannu N, et al. Hepatorenal syndrome: the 8th international consensus conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2012;16(1):R23.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Martin-Llahi M, Guevara M, Torre A, Fagundes C, Restuccia T, Gilabert R, et al. Prognostic importance of the cause of renal failure in patients with cirrhosis. Gastroenterology. 2011;140(2):488–96.e4.

    Article  PubMed  Google Scholar 

  9. Moreau R, Durand F, Poynard T, Duhamel C, Cervoni JP, Ichai P, et al. Terlipressin in patients with cirrhosis and type 1 hepatorenal syndrome: a retrospective multicenter study. Gastroenterology. 2002;122(4):923–30.

    Article  CAS  PubMed  Google Scholar 

  10. Wadei HM, Mai ML, Ahsan N, Gonwa TA. Hepatorenal syndrome: pathophysiology and management. Clin J Am Soc Nephrol. 2006;1(5):1066–79.

    Article  CAS  PubMed  Google Scholar 

  11. Schrier RW, Arroyo V, Bernardi M, Epstein M, Henriksen JH, Rodes J. Peripheral arterial vasodilation hypothesis: a proposal for the initiation of renal sodium and water retention in cirrhosis. Hepatology. 1988;8(5):1151–7.

    Article  CAS  PubMed  Google Scholar 

  12. Gaskari SA, Honar H, Lee SS. Therapy insight: cirrhotic cardiomyopathy. Nat Clin Pract Gastroenterol Hepatol. 2006;3(6):329–37.

    Article  CAS  PubMed  Google Scholar 

  13. Moller S, Henriksen JH. Cardiovascular complications of cirrhosis. Gut. 2008;57(2):268–78.

    Article  CAS  PubMed  Google Scholar 

  14. Oliver JA, Verna EC. Afferent mechanisms of sodium retention in cirrhosis and hepatorenal syndrome. Kidney Int. 2010;77(8):669–80.

    Article  CAS  PubMed  Google Scholar 

  15. Wadei HM, Gonwa TA. Hepatorenal syndrome in the intensive care unit. J Intensive Care Med. 2013;28(2):79–92.

    Google Scholar 

  16. Cardenas A. Hepatorenal syndrome: a dreaded complication of end-stage liver disease. Am J Gastroenterol. 2005;100(2):460–7.

    Article  PubMed  Google Scholar 

  17. Gines P, Guevara M, Arroyo V, Rodes J. Hepatorenal syndrome. Lancet. 2003;362(9398):1819–27.

    Article  CAS  PubMed  Google Scholar 

  18. 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):1637–48.

    Article  CAS  PubMed  Google Scholar 

  19. 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(3):397–417.

    Google Scholar 

  20. Fernandez J, Navasa M, Planas R, Montoliu S, Monfort D, Soriano G, et al. Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis. Gastroenterology. 2007;133(3):818–24.

    Article  CAS  PubMed  Google Scholar 

  21. Ruiz-del-Arbol L, Urman J, Fernandez J, Gonzalez M, Navasa M, Monescillo A, et al. Systemic, renal, and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis. Hepatology. 2003;38(5):1210–8.

    Article  PubMed  Google Scholar 

  22. Cardenas A, Gines P, Uriz J, Bessa X, Salmeron JM, Mas A, et al. Renal failure after upper gastrointestinal bleeding in cirrhosis: incidence, clinical course, predictive factors, and short-term prognosis. Hepatology. 2001;34(4 Pt 1):671–6.

    Article  CAS  PubMed  Google Scholar 

  23. Gluud LL, Christensen K, Christensen E, Krag A. Systematic review of randomized trials on vasoconstrictor drugs for hepatorenal syndrome. Hepatology. 2010;51(2):576–84.

    Article  CAS  PubMed  Google Scholar 

  24. Sagi SV, Mittal S, Kasturi KS, Sood GK. Terlipressin therapy for reversal of type 1 hepatorenal syndrome: a meta-analysis of randomized controlled trials. J Gastroenterol Hepatol. 2010;25(5):880–5.

    Article  CAS  PubMed  Google Scholar 

  25. Brensing KA, Textor J, Perz J, Schiedermaier P, Raab P, Strunk H, et al. Long term outcome after transjugular intrahepatic portosystemic stent-shunt in non-transplant cirrhotics with hepatorenal syndrome: a phase II study. Gut. 2000;47(2):288–95.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464–70.

    Article  CAS  PubMed  Google Scholar 

  27. Davenport A. Continuous renal replacement therapies in patients with liver disease. Semin Dial. 2009;22(2):169–72.

    Article  PubMed  Google Scholar 

  28. Vaid A, Chweich H, Balk EM, Jaber BL. Molecular adsorbent recirculating system as artificial support therapy for liver failure: a meta-analysis. ASAIO J. 2012;58(1):51–9.

    Article  CAS  PubMed  Google Scholar 

  29. Eason JD, Gonwa TA, Davis CL, Sung RS, Gerber D, Bloom RD. Proceedings of consensus conference on simultaneous liver kidney transplantation (SLK). Am J Transplant. 2008;8(11):2243–51.

    Article  CAS  PubMed  Google Scholar 

  30. Alessandria C, Ozdogan O, Guevara M, Restuccia T, Jimenez W, Arroyo V, et al. MELD score and clinical type predict prognosis in hepatorenal syndrome: relevance to liver transplantation. Hepatology. 2005;41(6):1282–9.

    Article  PubMed  Google Scholar 

  31. Ruiz R, Barri YM, Jennings LW, Chinnakotla S, Goldstein RM, Levy MF, et al. Hepatorenal syndrome: a proposal for kidney after liver transplantation (KALT). Liver Transpl. 2007;13(6):838–43.

    Article  PubMed  Google Scholar 

  32. Gines A, Escorsell A, Gines P, Salo J, Jimenez W, Inglada L, et al. Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gastroenterology. 1993;105(1):229–36.

    CAS  PubMed  Google Scholar 

  33. 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(7):834–9.

    Article  PubMed  Google Scholar 

  34. Marik PE, Wood K, Starzl TE. The course of type 1 hepato-renal syndrome post liver transplantation. Nephrol Dial Transplant. 2006;21(2):478–82.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Ojo AO, Held PJ, Port FK, Wolfe RA, Leichtman AB, Young EW, et al. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med. 2003;349(10):931–40.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Renal Department, Royal Free NHS Foundation Trust, Pond Street, London, NW3 2QG, UK

    Aisling O’Riordan MBBCh, BAO, MRCPI, MD

Authors
  1. Aisling O’Riordan MBBCh, BAO, MRCPI, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aisling O’Riordan MBBCh, BAO, MRCPI, MD .

Editor information

Editors and Affiliations

  1. UCL Department of Nephrology, Royal Free London NHS Foundation Trust, London, United Kingdom

    Mark Harber

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag London

About this chapter

Cite this chapter

O’Riordan, A. (2014). Hepatorenal Syndrome. In: Harber, M. (eds) Practical Nephrology. Springer, London. https://doi.org/10.1007/978-1-4471-5547-8_8

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-5547-8_8

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5546-1

  • Online ISBN: 978-1-4471-5547-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation