hepatorenal syndrome

Summary

Summary: Functional KIDNEY FAILURE in patients with liver disease, usually LIVER CIRRHOSIS or portal hypertension (HYPERTENSION, PORTAL), and in the absence of intrinsic renal disease or kidney abnormality. It is characterized by intense renal vasculature constriction, reduced renal blood flow, OLIGURIA, and sodium retention.

Top Publications

  1. Stadlbauer V, Stadlbauer V, Wright G, Banaji M, Mukhopadhya A, Mookerjee R, et al. Relationship between activation of the sympathetic nervous system and renal blood flow autoregulation in cirrhosis. Gastroenterology. 2008;134:111-9 pubmed publisher
    ..is critically dependent on renal perfusion pressure and that this contributes to the development of the hepatorenal syndrome. The aims of the study were to determine the relationship of renal blood flow and renal perfusion pressure ..
  2. Rifai K, Ernst T, Kretschmer U, Bahr M, Schneider A, Hafer C, et al. Prometheus--a new extracorporeal system for the treatment of liver failure. J Hepatol. 2003;39:984-90 pubmed
    ..A significant improvement of the biochemical milieu was observed already after two treatments. Prospective controlled studies with the Prometheus system are necessary to evaluate hard clinical end-points. ..
  3. Gines P, Guevara M, Arroyo V, Rodes J. Hepatorenal syndrome. Lancet. 2003;362:1819-27 pubmed
    b>Hepatorenal syndrome (HRS) is a common complication of advanced cirrhosis, characterised by renal failure and major disturbances in circulatory function. Renal failure is caused by intense vasoconstriction of the renal circulation...
  4. Nadim M, Kellum J, Davenport A, Wong F, Davis C, Pannu N, et al. Hepatorenal syndrome: the 8th International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2012;16:R23 pubmed publisher
    ..Since the original publication of the definition and diagnostic criteria for the hepatorenal syndrome (HRS), there have been major advances in our understanding of its pathogenesis...
  5. Wadei H, Mai M, Ahsan N, Gonwa T. Hepatorenal syndrome: pathophysiology and management. Clin J Am Soc Nephrol. 2006;1:1066-79 pubmed
  6. Nicković V, Kocic G, Bjelakovic G, Pavlovic R, Stojanovic I, Katanic R, et al. Diagnostic significance of nitrates and nitrites and L-arginine, in development of hepatorenal syndrome in patients with end stage alcoholic liver cirrhosis. Ren Fail. 2013;35:633-9 pubmed publisher
    b>Hepatorenal syndrome (HRS) represents a complication of the end-stage liver cirrhosis...
  7. Wong F. Recent advances in our understanding of hepatorenal syndrome. Nat Rev Gastroenterol Hepatol. 2012;9:382-91 pubmed publisher
    b>Hepatorenal syndrome (HRS) is a serious complication of advanced cirrhosis with ascites. HRS develops as a result of abnormal haemodynamics, leading to splanchnic and systemic vasodilatation, but renal vasoconstriction...
  8. Alessandria C, Debernardi Venon W, Carello M, Ceretto S, Rizzetto M, Marzano A. Midodrine in the prevention of hepatorenal syndrome type 2 recurrence: a case-control study. Dig Liver Dis. 2009;41:298-302 pubmed publisher
    b>Hepatorenal syndrome is a severe complication of cirrhosis. Treatment with terlipressin has currently the best efficacy pedigree, inducing hepatorenal syndrome reversal in a high proportion of patients...
  9. Sagi S, Mittal S, Kasturi K, Sood G. Terlipressin therapy for reversal of type 1 hepatorenal syndrome: a meta-analysis of randomized controlled trials. J Gastroenterol Hepatol. 2010;25:880-5 pubmed publisher
    b>Hepatorenal syndrome (HRS) is a serious complication of advanced liver disease and carries a poor prognosis. Recent trials have indicated that terlipressin may be effective in reversing HRS...

More Information

Publications62

  1. Lenz K. Hepatorenal syndrome--is it central hypovolemia, a cardiac disease, or part of gradually developing multiorgan dysfunction?. Hepatology. 2005;42:263-5 pubmed
  2. Krag A, Møller S, Henriksen J, Holstein Rathlou N, Larsen F, Bendtsen F. Terlipressin improves renal function in patients with cirrhosis and ascites without hepatorenal syndrome. Hepatology. 2007;46:1863-71 pubmed
    ..The vasoconstrictor terlipressin improves renal function in hepatorenal syndrome (HRS)...
  3. Yan C, Zhu D, Wang F. [Study on the expressions and roles of renal heat shock protein 72 and Toll-like receptor 4 in hepatorenal syndrome in rat]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2007;19:731-4 pubmed
    ..and roles of renal heat shock protein 72(HSP72) and Toll-like receptor 4(TLR4) during development of hepatorenal syndrome in rat...
  4. Wong F, Moore K, Dingemanse J, Jalan R. Lack of renal improvement with nonselective endothelin antagonism with tezosentan in type 2 hepatorenal syndrome. Hepatology. 2008;47:160-8 pubmed
    Renal vasoconstriction is a key factor in the development of hepatorenal syndrome (HRS) and may be secondary to increased activities of endothelin-1, a potent renal vasoconstrictor...
  5. Sanyal A, Boyer T, Garcia Tsao G, Regenstein F, Rossaro L, Appenrodt B, et al. A randomized, prospective, double-blind, placebo-controlled trial of terlipressin for type 1 hepatorenal syndrome. Gastroenterology. 2008;134:1360-8 pubmed publisher
    b>Hepatorenal syndrome (HRS) type 1 is a progressive functional renal failure in subjects with advanced liver disease...
  6. Tandon P, Bain V, Tsuyuki R, Klarenbach S. Systematic review: renal and other clinically relevant outcomes in hepatorenal syndrome trials. Aliment Pharmacol Ther. 2007;25:1017-28 pubmed
    Although reversal of pretransplant renal dysfunction in hepatorenal syndrome reduces post-transplant complications, the overall impact on morbidity and mortality requires clarification...
  7. Kiser T, MacLaren R, Fish D. Treatment of hepatorenal syndrome. Pharmacotherapy. 2009;29:1196-211 pubmed publisher
    b>Hepatorenal syndrome (HRS) is a type of renal failure that occurs in patients with advanced cirrhosis...
  8. Møller S, Bendtsen F, Henriksen J. Pathophysiological basis of pharmacotherapy in the hepatorenal syndrome. Scand J Gastroenterol. 2005;40:491-500 pubmed
    b>Hepatorenal syndrome (HRS) is a functional and reversible impairment of renal function in patients with severe cirrhosis...
  9. Wong F, Nadim M, Kellum J, Salerno F, Bellomo R, Gerbes A, et al. Working Party proposal for a revised classification system of renal dysfunction in patients with cirrhosis. Gut. 2011;60:702-9 pubmed publisher
    ..using keywords of cirrhosis, renal dysfunction, acute kidney injury (AKI), chronic kidney injury (CKD), and hepatorenal syndrome. Acute kidney injury will include all causes of acute deterioration of renal function as indicated by an ..
  10. Fabrizi F, Dixit V, Messa P, Martin P. Terlipressin for hepatorenal syndrome: A meta-analysis of randomized trials. Int J Artif Organs. 2009;32:133-40 pubmed
    b>Hepatorenal syndrome (HRS) is a severe complication of end-stage renal disease whose management still constitutes a big challenge. Various approaches have been used for hepatorenal syndrome treatment, including vasoconstrictor therapy...
  11. Esrailian E, Pantangco E, Kyulo N, Hu K, Runyon B. Octreotide/Midodrine therapy significantly improves renal function and 30-day survival in patients with type 1 hepatorenal syndrome. Dig Dis Sci. 2007;52:742-8 pubmed
    Type 1 hepatorenal syndrome (HRS) can be a rapidly fatal consequence of liver failure. Recent studies have utilized vasoconstrictor therapies to combat splanchnic vasodilatation...
  12. Kiser T, Fish D, Obritsch M, Jung R, MacLaren R, Parikh C. Vasopressin, not octreotide, may be beneficial in the treatment of hepatorenal syndrome: a retrospective study. Nephrol Dial Transplant. 2005;20:1813-20 pubmed
    b>Hepatorenal syndrome (HRS) is a severe complication of cirrhosis and is associated with high mortality. Ornipressin and terlipressin are effective in treatment of HRS, but are not available in the USA...
  13. Solanki P, Chawla A, Garg R, Gupta R, Jain M, Sarin S. Beneficial effects of terlipressin in hepatorenal syndrome: a prospective, randomized placebo-controlled clinical trial. J Gastroenterol Hepatol. 2003;18:152-6 pubmed
    b>Hepatorenal syndrome (HRS) occurs in about 18% of cirrhotic patients with ascites and is characterized by intense renal vasoconstriction, low glomerular filtration rate and preserved tubular function and normal renal histology...
  14. Sen S, Mookerjee R, Jalan R. Terlipressin-induced vasoconstriction reversed with N-acetylcysteine: a case for combined use in hepatorenal syndrome?. Gastroenterology. 2002;123:2160-1 pubmed
  15. Arroyo V. Review article: albumin in the treatment of liver diseases--new features of a classical treatment. Aliment Pharmacol Ther. 2002;16 Suppl 5:1-5 pubmed
    ..have clearly demonstrated its efficacy in the prevention and treatment of circulatory dysfunction and hepatorenal syndrome in patients with cirrhosis...
  16. Skagen C, Einstein M, Lucey M, Said A. Combination treatment with octreotide, midodrine, and albumin improves survival in patients with type 1 and type 2 hepatorenal syndrome. J Clin Gastroenterol. 2009;43:680-5 pubmed publisher
    Few therapeutic modalities exist for the treatment of hepatorenal syndrome (HRS)...
  17. Rajekar H, Chawla Y. Terlipressin in hepatorenal syndrome: Evidence for present indications. J Gastroenterol Hepatol. 2011;26 Suppl 1:109-14 pubmed publisher
    b>Hepatorenal syndrome (HRS) is the most frequent life threatening complication of advanced liver failure and cirrhosis...
  18. Velez J, Nietert P. Therapeutic response to vasoconstrictors in hepatorenal syndrome parallels increase in mean arterial pressure: a pooled analysis of clinical trials. Am J Kidney Dis. 2011;58:928-38 pubmed publisher
    Vasoconstrictor therapy has been advocated as treatment for hepatorenal syndrome (HRS)...
  19. Chang Y, Qi X, Li Z, Wang F, Wang S, Zhang Z, et al. Hepatorenal syndrome: insights into the mechanisms of intra-abdominal hypertension. Int J Clin Exp Pathol. 2013;6:2523-8 pubmed
    b>Hepatorenal syndrome is one of the serious complications of cirrhosis and closely associated with the increasing intra-abdominal pressure (IAP)...
  20. Testino G, Ferro C, Sumberaz A, Messa P, Morelli N, Guadagni B, et al. Type-2 hepatorenal syndrome and refractory ascites: role of transjugular intrahepatic portosystemic stent-shunt in eighteen patients with advanced cirrhosis awaiting orthotopic liver transplantation. Hepatogastroenterology. 2003;50:1753-5 pubmed
    ..Its role in the management of refractory ascites and hepatorenal syndrome still awaits further prospective studies. Type-2 hepatorenal syndrome is a moderate steady renal impairment...
  21. Wong F, Pantea L, Sniderman K. Midodrine, octreotide, albumin, and TIPS in selected patients with cirrhosis and type 1 hepatorenal syndrome. Hepatology. 2004;40:55-64 pubmed
    b>Hepatorenal syndrome (HRS) is a functional renal disorder complicating decompensated cirrhosis. Treatments to date, except liver transplantation, have been able to improve but not normalize renal function...
  22. Rifai K, Ernst T, Kretschmer U, Hafer C, Haller H, Manns M, et al. The Prometheus device for extracorporeal support of combined liver and renal failure. Blood Purif. 2005;23:298-302 pubmed
    ..Therefore, it is a promising treatment option for patients with hepatorenal syndrome (HRS). We studied 10 patients with HRS in a prospective clinical study...
  23. Nazar A, Pereira G, Guevara M, Martín Llahí M, Pepin M, Marinelli M, et al. Predictors of response to therapy with terlipressin and albumin in patients with cirrhosis and type 1 hepatorenal syndrome. Hepatology. 2010;51:219-26 pubmed publisher
    Terlipressin plus albumin is an effective treatment for type 1 hepatorenal syndrome (HRS), but approximately only half of the patients respond to this therapy...
  24. Ortega R, Gines P, Uriz J, Cardenas A, Calahorra B, de Las Heras D, et al. Terlipressin therapy with and without albumin for patients with hepatorenal syndrome: results of a prospective, nonrandomized study. Hepatology. 2002;36:941-8 pubmed
    Vasopressin analogues associated with albumin improve renal function in hepatorenal syndrome (HRS)...
  25. Al Khuwaitir T, Al Moghairi A, Sherbeeni S, Al Ghamdi A. Rift Valley fever hepatitis complicated by disseminated intravascular coagulation and hepatorenal syndrome. Saudi Med J. 2004;25:528-31 pubmed
  26. Neri S, Pulvirenti D, Malaguarnera M, Cosimo B, Bertino G, Ignaccolo L, et al. Terlipressin and albumin in patients with cirrhosis and type I hepatorenal syndrome. Dig Dis Sci. 2008;53:830-5 pubmed
    b>Hepatorenal syndrome (HRS) is a pre-renal-like dysfunction that generally onsets in cirrhotic patients presenting ascites...
  27. Seo Y, Jung E, An H, Kim J, Jung Y, Kim J, et al. Serum cystatin C level is a good prognostic marker in patients with cirrhotic ascites and normal serum creatinine levels. Liver Int. 2009;29:1521-7 pubmed publisher
    ..The endpoint of follow-up was the development of hepatorenal syndrome (HRS) or mortality...
  28. Salerno F, Gerbes A, Gines P, Wong F, Arroyo V. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Gut. 2007;56:1310-8 pubmed
  29. Ruiz R, Barri Y, Jennings L, Chinnakotla S, Goldstein R, Levy M, et al. Hepatorenal syndrome: a proposal for kidney after liver transplantation (KALT). Liver Transpl. 2007;13:838-43 pubmed
    b>Hepatorenal syndrome (HRS) is a well-recognized complication of end-stage liver disease...
  30. Barreto R, Fagundes C, Guevara M, Solá E, Pereira G, Rodríguez E, et al. Type-1 hepatorenal syndrome associated with infections in cirrhosis: natural history, outcome of kidney function, and survival. Hepatology. 2014;59:1505-13 pubmed publisher
    Type-1 hepatorenal syndrome (HRS) is a common complication of bacterial infections in cirrhosis, but its natural history remains undefined...
  31. Gungor G, Ataseven H, Demir A, Solak Y, Gaipov A, Biyik M, et al. Neutrophil gelatinase-associated lipocalin in prediction of mortality in patients with hepatorenal syndrome: a prospective observational study. Liver Int. 2014;34:49-57 pubmed publisher
    b>Hepatorenal syndrome (HRS) is a severe complication of cirrhosis which is characterized by renal dysfunction and associated with poor survival...
  32. Danalioglu A, Cakaloglu Y, Karaca C, Aksoy N, Akyuz F, Ozdil S, et al. Terlipressin and albumin combination treatment in hepatorenal syndrome. Hepatogastroenterology. 2003;50 Suppl 2:ccciii-cccv pubmed
    b>Hepatorenal syndrome (HRS) is a severe complication of cirrhosis, leading to death in nearly all of cases in the absence of liver transplantation. Several treatments have been attempted as a bridge to liver transplantation...
  33. Avidan B. The use of albumin in all patients with decompensated cirrhosis is not justified. Isr Med Assoc J. 2005;7:118-20 pubmed
  34. Al Sibae M, Cappell M. Accuracy of MELD scores in predicting mortality in decompensated cirrhosis from variceal bleeding, hepatorenal syndrome, alcoholic hepatitis, or acute liver failure as well as mortality after non-transplant surgery or TIPS. Dig Dis Sci. 2011;56:977-87 pubmed publisher
    ..demonstrating that MELD scores relatively accurately predict mortality in patients with variceal bleeding, hepatorenal syndrome, alcoholic hepatitis, and acute liver failure, as well as assess risks of non-liver transplantation surgery ..
  35. Martín Llahí M, Pepin M, Guevara M, Diaz F, Torre A, Monescillo A, et al. Terlipressin and albumin vs albumin in patients with cirrhosis and hepatorenal syndrome: a randomized study. Gastroenterology. 2008;134:1352-9 pubmed publisher
    b>Hepatorenal syndrome is common in patients with advanced cirrhosis and constitutes a major problem in liver transplantation. There is no effective medical treatment for hepatorenal syndrome...
  36. Sharma P, Kumar A, Shrama B, Sarin S. An open label, pilot, randomized controlled trial of noradrenaline versus terlipressin in the treatment of type 1 hepatorenal syndrome and predictors of response. Am J Gastroenterol. 2008;103:1689-97 pubmed publisher
    b>Hepatorenal syndrome (HRS) is characterized by functional renal failure in end-stage liver disease. Terlipressin is the drug of choice for treating type 1 HRS (HRS-1). It is expensive and often not readily available...
  37. Appenrodt B, Zielinski J, Brensing K, Heller J, Sauerbruch T, Schepke M. Degree of hepatic dysfunction and improvement of renal function predict survival in patients with HRS type I: a retrospective analysis. Eur J Gastroenterol Hepatol. 2009;21:1428-32 pubmed publisher
    b>Hepatorenal syndrome (HRS) is a frequent complication of end-stage liver cirrhosis. HRS type I has a very poor prognosis...
  38. Umgelter A, Reindl W, Wagner K, Franzen M, Stock K, Schmid R, et al. Effects of plasma expansion with albumin and paracentesis on haemodynamics and kidney function in critically ill cirrhotic patients with tense ascites and hepatorenal syndrome: a prospective uncontrolled trial. Crit Care. 2008;12:R4 pubmed publisher
    ..This study investigates the short-term effects of paracentesis on haemodynamics and kidney function in volume resuscitated patients with HRS...
  39. Ruiz R, Kunitake H, Wilkinson A, Danovitch G, Farmer D, Ghobrial R, et al. Long-term analysis of combined liver and kidney transplantation at a single center. Arch Surg. 2006;141:735-41; discussion 741-2 pubmed
    ..transplantation (CLKT) for patients with chronic primary diseases of both organs and for patients with hepatorenal syndrome. Retrospective case series. Multiorgan transplantation service in a large university medical center...
  40. Boyer T, Sanyal A, Garcia Tsao G, Blei A, Carl D, Bexon A, et al. Predictors of response to terlipressin plus albumin in hepatorenal syndrome (HRS) type 1: relationship of serum creatinine to hemodynamics. J Hepatol. 2011;55:315-21 pubmed publisher
    ..0mg/dl). A sustained rise in MAP is required for HRS reversal. As MAP is a surrogate marker for the hyperdynamic circulation, it is only with improvement in the hyperdynamic circulation that HRS reversal is observed. ..
  41. Muñoz L, Alcalá E, Cordero P, Martinez M, Vázquez N, Galindo S, et al. Reversal of hepatorenal syndrome in cirrhotic patients with terlipressin plus albumin. First experience in Mexico. Ann Hepatol. 2009;8:207-11 pubmed
    Type 1 hepatorenal syndrome (HRS) is a functional renal failure that complicates end-stage cirrhosis. The vasopressin analogue terlipressin has been associated with improved renal function in patients with type 1 HRS...
  42. Witzke O, Baumann M, Patschan D, Patschan S, Mitchell A, Treichel U, et al. Which patients benefit from hemodialysis therapy in hepatorenal syndrome?. J Gastroenterol Hepatol. 2004;19:1369-73 pubmed
    b>Hepatorenal syndrome (HRS) occurs in patients with advanced liver cirrhosis and has a poor outcome. The aim of the present study was to investigate which patients with HRS are likely to benefit from hemodialysis...
  43. Testro A, Wongseelashote S, Angus P, Gow P. Long-term outcome of patients treated with terlipressin for types 1 and 2 hepatorenal syndrome. J Gastroenterol Hepatol. 2008;23:1535-40 pubmed
    Studies suggest that terlipressin is effective in the treatment of hepatorenal syndrome (HRS). However, factors predicting response to therapy and the long-term outcome of patients have not been defined...
  44. Krag A, Borup T, Møller S, Bendtsen F. Efficacy and safety of terlipressin in cirrhotic patients with variceal bleeding or hepatorenal syndrome. Adv Ther. 2008;25:1105-40 pubmed publisher
    ..used in the treatment of patients with cirrhosis and bleeding esophageal varices (BEV) and in patients with hepatorenal syndrome (HRS): two of the most dramatic and feared complications of cirrhosis...
  45. Wong F. Drug insight: the role of albumin in the management of chronic liver disease. Nat Clin Pract Gastroenterol Hepatol. 2007;4:43-51 pubmed
    ..Newer indications in cirrhotic patients include preventing hepatorenal syndrome in those with spontaneous bacterial peritonitis, and treating established hepatorenal syndrome in ..
  46. Ahn H, Kim Y, Kim S, Kim H, Min S, Jeong S, et al. Cystatin C is a good predictor of hepatorenal syndrome and survival in patients with cirrhosis who have normal serum creatinine levels. Hepatogastroenterology. 2012;59:1168-73 pubmed publisher
    ..The endpoints of the study were either development of hepatorenal syndrome or mortality...
  47. Rahman E, Al Suwaida A, Askar A. Single pass albumin dialysis in hepatorenal syndrome. Saudi J Kidney Dis Transpl. 2008;19:479-84 pubmed
    b>Hepatorenal syndrome (HRS) is the most appalling complication of acute or chronic liver disease with 90% mortality rate. Single pass albumin dialysis (SPAD) can be considered as a noble liver support technique in HRS...
  48. Rossle M, Gerbes A. TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax: a critical update. Gut. 2010;59:988-1000 pubmed publisher
    Refractory ascites is a frequent complication of advanced cirrhosis and is associated with hepatorenal syndrome and hepatic hydrothorax...
  49. Umgelter A, Reindl W, Franzen M, Lenhardt C, Huber W, Schmid R. Renal resistive index and renal function before and after paracentesis in patients with hepatorenal syndrome and tense ascites. Intensive Care Med. 2009;35:152-6 pubmed publisher
    ..Twelve spontaneously breathing cirrhotic patients with hepatorenal syndrome, tense ascites and a clinical indication for paracentesis. Paracentesis and substitution of albumin...
  50. Gluud L, Christensen K, Christensen E, Krag A. Systematic review of randomized trials on vasoconstrictor drugs for hepatorenal syndrome. Hepatology. 2010;51:576-84 pubmed publisher
    Vasoconstrictor drugs may improve renal function in hepatorenal syndrome (HRS), but the effect on mortality has not been established...
  51. Sussman A, Boyer T. Management of refractory ascites and hepatorenal syndrome. Curr Gastroenterol Rep. 2011;13:17-25 pubmed publisher
    ..Lastly, the development of hepatorenal syndrome indicates the patient's liver disease is advanced, and transplantation again is the best option...
  52. Arroyo V, Fernandez J, Gines P. Pathogenesis and treatment of hepatorenal syndrome. Semin Liver Dis. 2008;28:81-95 pubmed publisher
    b>Hepatorenal syndrome (HRS) is a functional renal failure that frequently develops in patients with advanced cirrhosis and severe impairment in systemic circulatory function...
  53. Alessandria C, Ottobrelli A, Debernardi Venon W, Todros L, Cerenzia M, Martini S, et al. Noradrenalin vs terlipressin in patients with hepatorenal syndrome: a prospective, randomized, unblinded, pilot study. J Hepatol. 2007;47:499-505 pubmed
    Treatment of hepatorenal syndrome (HRS) is based on vasoconstrictors. Terlipressin is the one with the soundest evidence. Noradrenalin has been suggested as an effective alternative...