A critical review on the recent developments on hepatorenal syndrome

Abstract

Hepatorenal syndrome (HRS) is a life-threatening complication of AKI in liver cirrhosis. It is a type of functional renal failure occurring due to the progression of splanchnic vasodilation in patients with liver cirrhosis, end-stage liver failure and occasionally in fulminant hepatitis. Initially, HRS was classified as type 1 HRS and type 2 HRS, but nowadays the International Club of Ascites (ICA) has revised the definition and classification of HRS based on pathophysiological characteristics and clinical scenario as HRS AKI and Non-HRS AKI, which differentiates AKI based on the evidence of any intrinsic renal disease or presence of nephrotoxic agents. Cardiac arrhythmias, endotoxemia and refractory ascites contribute to low survival rate and hence increases the risk in HRS. Early diagnosis is the key strategy for successful management of HRS. The goal of HRS management is the reversal of the syndrome by prompt identification and management of underlying cause and to correct hemodynamic instabilities by volume expanders. Management of HRS includes a combination of vasopressor therapy with plasma expanders like albumin which accounts for almost 80 % of survival rate in responders to the treatment. Recent studies suggest non-pharmacological prevention of HRS with the use of a combination of green tea extract with a probiotic mixture for fighting against the high oxidative stress and endotoxemia in HRS.