End‐stage liver disease: Management of hepatorenal syndrome

Abstract

Hepatorenal syndrome (HRS) is a serious complication of cirrhosis with high morbidity and mortality rates. Recently, the definition of HRS type 1 has been updated and is now called HRS‐AKI. This new definition reduces the risk of delaying HRS treatment and eliminates the need to establish a minimum creatinine cut‐off for the diagnosis of HRS‐AKI. From a pathophysiological point of view, newly identified mechanisms involved in the development of HRS are related to the inflammatory response, conditioning the development of extrahepatic organ dysfunction in patients with cirrhosis. One of the main challenges for the diagnosis of HRS is the validation of new biomarkers to obtain an early and differential diagnosis of kidney injury (eg HRS vs. ATN). Treatment of HRS is based on the use of vasoconstrictive agents in combination with albumin and terlipressin is the most widely used vasoconstrictor drug, with a high response rate. The effects of a continuous infusion of terlipressin at a dose of 2‐12 mg/day was similar to bolus administration, but with lower rates of adverse events. Finally, MELD/MELD‐Na which includes creatinine as one of its main determinants gives AKI‐HRS patients priority on the waiting list (WL) for liver transplant (LT). However, the MELD and MELD‐Na scores are reduced in responding patients, resulting a longer waiting time in these patients than in non‐responders. Thus, the initial MELD/MELD‐Na score (pre‐treatment value) should be used to prioritize patients on the WL for LT in these cases.

Scavenger receptor A-mediated nanoparticles target M1 macrophages for acute liver injury

“…One of the universal liver diseases worldwide, acute liver injury (ALI) can rapidly develop into life-threatening acute liver failure with limited treatment [1] , [2] , [3] . The hepatic macrophages, also called Kupffer cells, the most numerous immune cells in the liver, are situated in the hepatic sinusoids and provide a crucial function in varied liver diseases [4] .…”

Prognostic Nomograms for Hospital Survival and Transplant-Free Survival of Patients with Hepatorenal Syndrome: A Retrospective Cohort Study

“…The Child–Pugh score has been widely used to evaluate the hepatic reserve capacity. The model for end-stage liver disease (MELD)/MELD–Na score includes serum creatinine (sCr), which serves as one of the main determinants of the score, and priority is given to LT when it is applied to a prognostic prediction in cases of decompensated cirrhosis with HRS [ 12 ]. In addition, some studies have focused on the prognostic prediction of HRS.…”