Hepatorenal syndrome: A review into changing definition, diagnostic criteria, pathophysiology, and management

• Main Authors: Vishal Bodh, Brij Sharma, Rajesh Sharma
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2020-01-01
• Series: CHRISMED Journal of Health and Research
• Subjects: acute kidney disease; acute kidney injury; chronic kidney disease; glomerular filtration rate; hepatorenal syndrome
• Online Access: http://www.cjhr.org/article.asp?issn=2348-3334;year=2020;volume=7;issue=2;spage=83;epage=89;aulast=Bodh

Hepatorenal syndrome (HRS) is a form of kidney function impairment that characteristically occurs in patients with cirrhosis. The diagnostic criteria for this syndrome have been revised throughout the years, with recent revisions aimed at improving earlier diagnosis and treatment. HRS definition has been updated recently by the International Club of Ascites in accordance with Kidney Disease Improving Global Outcomes acute kidney injury (AKI) classification. Recent changes in terminology have led to acute or Type I HRS being referred to as AKI-HRS and chronic or Type II HRS as chronic kidney disease (CKD)-HRS. The contribution of systemic inflammation, a key feature of cirrhosis, in the development of HRS has been highlighted in recent years. The current standard of care for the management of HRS involves the use of vasoconstrictor therapy and volume expansion with albumin. All patients do not respond to treatment, and even in those who respond, early mortality rates are very high in the absence of liver transplantation (LT). LT is the only curative treatment of HRS.