Kiani C, Zori AG. Recent advances in pathophysiology, diagnosis and management of hepatorenal syndrome: A review. World J Hepatol 2023; 15(6): 741-754 [PMID: 37397940 DOI: 10.4254/wjh.v15.i6.741]
Corresponding Author of This Article
Andreas G Zori, MD, Assistant Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Florida, 1600 SW Archer Road, Gainesville, FL 32610, United States. andreas.zori@medicine.ufl.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Jun 27, 2023; 15(6): 741-754 Published online Jun 27, 2023. doi: 10.4254/wjh.v15.i6.741
Recent advances in pathophysiology, diagnosis and management of hepatorenal syndrome: A review
Calvin Kiani, Andreas G Zori
Calvin Kiani, Andreas G Zori, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Florida, Gainesville, FL 32610, United States
Author contributions: Kiani C drafted the initial manuscript; Zori AG contributed to, edited, and drafted the final manuscript.
Conflict-of-interest statement: Andreas G Zori and Calvin Kiani have no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Andreas G Zori, MD, Assistant Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Florida, 1600 SW Archer Road, Gainesville, FL 32610, United States. andreas.zori@medicine.ufl.edu
Received: February 28, 2023 Peer-review started: February 28, 2023 First decision: March 10, 2023 Revised: April 18, 2023 Accepted: May 6, 2023 Article in press: May 6, 2023 Published online: June 27, 2023
Abstract
Hepatorenal syndrome with acute kidney injury (HRS-AKI) is a form of rapidly progressive kidney dysfunction in patients with decompensated cirrhosis and/or acute severe liver injury such as acute liver failure. Current data suggest that HRS-AKI occurs secondary to circulatory dysfunction characterized by marked splanchnic vasodilation, leading to reduction of effective arterial blood volume and glomerular filtration rate. Thus, volume expansion and splanchnic vasoconstriction constitute the mainstay of medical therapy. However, a significant proportion of patients do not respond to medical management. These patients often require renal replacement therapy and may be eligible for liver or combined liver-kidney transplantation. Although there have been advances in the management of patients with HRS-AKI including novel biomarkers and medications, better-calibrated studies, more widely available biomarkers, and improved prognostic models are sorely needed to further improve diagnosis and treatment of HRS-AKI.
Core Tip: Hepatorenal syndrome (HRS) is a specific form of acute kidney injury that occurs in the presence of severe acute liver injury (e.g., acute liver failure or severe alcoholic hepatitis), decompensated cirrhosis, or acute on chronic liver failure and is particularly associated with poor prognosis. Here, we reviewed some of the recent advancements in the diagnosis and treatment of HRS.
