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Hepatorenal syndrome
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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“in keeping with coupled hepatic and kidney function, observed clinically as hepatorenal syndrome.43”
From Cystatin C is glucocorticoid responsive, directs recruitment of Trem2+ macrophages, and predicts failure of cancer immunotherapy (2023) · cites this paper as [43]
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Self-citation
Metadata
- 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
- Venue
- Nature Reviews Disease Primers
- Published
- 2018-09-13
- Volume
- 4
- Issue
- 1
- Pages
- 23-23
- ISSN
- 2056-676X (ISSN-L)
- 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
- 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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