Cited by 260Liver Disease and TransplantationElectrolyte and hormonal disordersAcute Kidney Injury Research

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Hepatorenal syndrome

Ginès, Pere, Solà, Elsa, Angeli, Paolo, Wong, Florence, Nadim, Mitra K., Kamath, Patrick S.·2018·Nature Reviews Disease Primers

DOI 10.1038/s41572-018-0022-7

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Abstract

Hepatorenal syndrome (HRS) is a form of kidney function impairment that characteristically occurs in cirrhosis. Recent changes in terminology have led to acute HRS being referred to as acute kidney injury (AKI)-HRS and chronic HRS as chronic kidney disease (CKD)-HRS. AKI-HRS is characterized by a severe impairment of kidney function owing to vasoconstriction of the renal arteries in the absence of substantial abnormalities in kidney histology. Pathogenetic mechanisms involve disturbances in circulatory function due to a marked splanchnic arterial vasodilation, which triggers the activation of vasoconstrictor factors. An intense systemic inflammatory reaction that is characteristic of advanced cirrhosis may also be involved. The main triggering factors of AKI-HRS are bacterial infections, particularly spontaneous bacterial peritonitis. The diagnosis of AKI-HRS is a challenge because of a lack of specific diagnostic tools and mainly involves the differential diagnosis from other forms of AKI, particularly acute tubular necrosis. The prognosis of patients with AKI-HRS is poor, with a median survival of ≤3 months. The ideal treatment for AKI-HRS is liver transplantation in patients without contraindications. Medical therapy consists of vasoconstrictor drugs to counteract splanchnic arterial vasodilation together with volume expansion with albumin. Effective measures to prevent AKI-HRS include early identification and treatment of bacterial infections and the administration of albumin in patients with spontaneous bacterial peritonitis.

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Authors: Ginès, P., Solà, E., Angeli, P., Wong, F., Nadim, M. K., & Kamath, P. S.
Affiliations: Hospital Clínic de Barcelona (ES)
University of Padua (IT)
University of Toronto (CA)
University of Southern California (US)
Mayo Clinic (US)
Corresponding author: Ginès, Pere
ORCID: Ginès, Pere
Solà, Elsa
Angeli, Paolo
Wong, Florence
Nadim, Mitra K.
Kamath, Patrick S.
Venue: Nature Reviews Disease Primers
Publisher: Springer Science and Business Media LLC
Published: 2018-09-13
Volume: 4
Issue: 1
Pages: 23-23
ISSN: 2056-676X (ISSN-L)
DOI: 10.1038/s41572-018-0022-7
OpenAlex: W4211060913
Cited by: 260
References: 155
Citations by year: 2026: 22 · 2025: 31 · 2024: 38 · 2023: 56 · 2022: 32 · 2021: 44 · 2020: 25 · 2019: 9 · 2018: 2
FWCI: 2.70
Type: journal article
Language: en
Update notices: correction (2018-10-15)
Open access: closed
Licence: www.springernature.com/gp/researchers/text-and-data-mining (tdm)
www.springernature.com/gp/researchers/text-and-data-mining (vor)
Locations: Nature Reviews Disease Primers (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
Health Sciences › Medicine › Nephrology › Electrolyte and hormonal disorders
Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
Keywords: hepatorenal syndrome, acute kidney injury, chronic kidney disease, liver cirrhosis, renal vasoconstriction, splanchnic vasodilation, systemic inflammation, spontaneous bacterial peritonitis, acute tubular necrosis, liver transplantation, albumin, vasoconstrictor therapy, prevention
MeSH terms: Lipocalin-2, Hepatitis A Virus Cellular Receptor 1, Terlipressin, Bacterial Infections, Creatinine, Hepatorenal Syndrome, Humans, Inflammation, Liver Cirrhosis, Risk Factors, Serum Albumin, Vasoconstrictor Agents, Biomarkers, Interleukin-18, Fatty Acid-Binding Proteins, Acute Kidney Injury

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