Sindromul hepatorenal

Abstract

Background: Hepatorenal syndrome (HRS) is a serious complication of severe liver disease usually occurs in advanced stage of liver cirrhosis and acute fulminant hepatitis. HRS develops as a result of kidney hemodynamic changes occurring in severe liver disease and manifests as acute renal failure, functional, potentially reversible in the absence of renal histological changes. Type 1 HRS is characterized by rapidly progressive reduction in renal function. Type 1 HRS is often induced by acute precipitating factors such as bacterial infections, gastrointestinal bleeding and large volume paracentesis without plasma volume compensation. The decline in renal function is slow and progressive in type 2 HRS. Development of type 2 HRS is not dependent on acute events and is characterized by a progressive deterioration of renal function related to the degree of portal hypertension. Patients with type 2 HRS can spontaneously develop type 1 HRS manifested by acute functional renal failure in case of any precipitating factors. Conclusions: Liver transplantation is the most effective method of treatment for HRS. Terlipressin, an analogue of vasopressin, improves renal perfusion by inducing vasoconstriction in the territory of the splanchnic circulation. Terlipressin and albumin combination therapy significantly improves the prognosis of patients with HRS. Continuous treatment with terlipressin until liver transplantation in patients with HRS recurrence after the first treatment is a good option for the period until liver transplantation. Combined pharmacological therapy (terlipressin plus albumin) reduces the rate of non-responders in patients with relapse. Renal replacement therapy serves as a bridge to transplantation in patients awaiting liver transplant.