A Comprehensive Systematic Review of the Latest Management Strategies for Hepatorenal Syndrome: A Complicated Syndrome to Tackle

Abstract

Hepatorenal syndrome (HRS), defined by the extreme manifestation of renal impairment in patients with cirrhosis, is characterized by reduced renal blood flow and glomerular filtration rate. It is diagnosed with reduced kidney function confirming the absence of intrinsic kidney disease, such as hematuria or proteinuria. HRS is potentially reversible with liver transplantation or vasoconstrictor drugs. The condition carries a poor prognosis with high mortality rates, particularly in patients with advanced cirrhosis. The latest management for HRS involves a combination of pharmacological and non-pharmacological interventions, aiming to improve renal function and reduce the risk of mortality. Pharmacological treatments include vasoconstrictors, such as terlipressin and midodrine, and albumin infusion, which have been shown to improve renal function and reduce mortality in HRS patients. Non-pharmacological interventions, including invasive procedures such as transjugular intrahepatic portosystemic shunt (TIPS), plasma exchange, liver transplantation, and renal replacement therapy, may also be considered. Though TIPS has been shown to be effective in improving renal function in HRS patients, liver transplantation remains at the top of the consideration for the treatment of end-stage liver disease and HRS. Recent studies have placed importance on early recognition and prompt intervention in HRS patients, as delaying treatment can result in poorer outcomes. Although there are numerous reviews that summarize various aspects of HRS, the recent advancements in the management and pathophysiology of HRS are still insufficient. Therefore, in this review, we summarized a brief pathophysiology and highlighted recent advancements in the management of HRS with a quick review of the latest articles.

Management of hepatorenal syndrome and associated outcomes: a systematic review

“… 3 43 Which bind to V1 receptors on vascular smooth muscle, affecting vasoconstriction, primarily of the splanchnic and extrarenal circulations that affects the increased effective circulating volume and renal perfusion pressures. 44 …”

“…Protected by http://bmjopengastro.bmj.com/ access affecting vasoconstriction, primarily of the splanchnic and extrarenal circulations that affects the increased effective circulating volume and renal perfusion pressures. 44 In this study, 24 articles were conducted terlipressin alone or compared with placebo/other treatments. A higher rate of HRS reversal was detected for terlipressin in 17 studies, which was significant in 10 of them.…”

Hepatorenal Syndrome—Novel Insights into Diagnostics and Treatment

“…Further decompensation events such as refractory ascites, spontaneous bacterial peritonitis, hepatorenal syndrome (HRS), recurrent hepatic encephalopathy, and variceal bleeding further reduce survival [2,3]. HRS, in particular, has an extremely poor prognosis, necessitating early identification and understanding of the syndrome [4].…”

“…The HRS is characterized by renal failure and major disturbances in circulatory function. The HRS is a diagnosis of exclusion and occurs with equal frequency in both sexes [4,6]. The incidence of HRS varies from 7% to 45% [7][8][9][10].…”

“…HRS-AKI is regarded as the most common fatal complication in patients with cirrhosis. Nevertheless, HRS is associated with poor prognosis with high mortality rates, notably in individuals with advanced cirrhosis [4,14].…”