Hepatorenal syndrome in patients with cirrhosis

Abstract

Introduction: Hepatorenal syndrome (HRS) represents a common complication of severe forms of cirrhosis, characterized by renal failure apparent with no specific cause, which is progressive and theoretical is reversible. After the diagnosis is being established, the probability that a cirrhotic patient would develop a HRS is 18 % in 10 years and 39% in 5 years. SHR develops usually in patients with cirrhosis, frequently with alcoholic etiology and already presents all the severe complications of the disease. The hepatorenal syndrome is a diagnosis of exclusion and is associated with a poor prognosis. Methods: The study was carried out during a 5 year period (2007-2012). We selected 447 patients with different evolution stages of cirrhosis. The diagnosis was based on anamnesis, clinical examination, biological explorations and imaging scans. Our study group was analyzed from demographical point of view and also etiological and compensation type. The severity was evaluated with Child-Pugh-Turcotte score, being dosed serum albumin and protrombine time. On the basis of these criteria was elaborated the prognosis. Results and discussions: The HRS is a frequent complication in cirrhosis evolution. The most common progression of cirrhosis, no matter the etiology or Child score, is to HRS type 2. Death in 6 months usually occurs in patients with ethanolic cirrhosis. It generally emerges in male patients from urban environment. HRS type 2 develops in male with Child C class cirrhosis and is usually followed by death. Conclusions: HRS is present in the evolution of any patient with cirrhosis, independent of the etiological factors and environment. Child score is not influenced by cirrhosis etiology, but it might complicate the disease during its evolution. With nowadays therapeutical methods, cirrhosis complication succeeded by HRS has a low chance of survival improvement. Death is the most common form of evolution of HRS.