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2017 ; 9
(6
): 293-299
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Hepatorenal syndrome: Update on diagnosis and therapy
#MMPMID28293378
Acevedo JG
; Cramp ME
World J Hepatol
2017[Feb]; 9
(6
): 293-299
PMID28293378
show ga
Hepatorenal syndrome (HRS) is a manifestation of extreme circulatory dysfunction
and entails high morbidity and mortality. A new definition has been recently
recommended by the International Club of Ascites, according to which HRS
diagnosis relies in serum creatinine changes instead that on a fixed high value.
Moreover, new data on urinary biomarkers has been recently published. In this
sense, the use of urinary neutrophil gelatinase-associated lipocalin seems useful
to identify patients with acute tubular necrosis and should be employed in the
diagnostic algorithm. Treatment with terlipressin and albumin is the current
standard of care. Recent data show that terlipressin in intravenous continuous
infusion is better tolerated than intravenous boluses and has the same efficacy.
Terlipressin is effective in reversing HRS in only 40%-50% of patients. Serum
bilirubin and creatinine levels along with the increase in blood pressure and the
presence of systemic inflammatory response syndrome have been identified as
predictors of response. Clearly, there is a need for further research in novel
treatments. Other treatments have been assessed such as noradrenaline, dopamine,
transjugular intrahepatic portosystemic shunt, renal and liver replacement
therapy, etc. Among all of them, liver transplant is the only curative option and
should be considered in all patients. HRS can be prevented with volume expansion
with albumin during spontaneous bacterial peritonitis and after post large volume
paracentesis, and with antibiotic prophylaxis in patients with advanced cirrhosis
and low proteins in the ascitic fluid. This manuscript reviews the recent
advances in the diagnosis and management of this life-threatening condition.