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Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis.
Postgrad Med J. 2008 Dec;84(998):662-70
Salerno F, Gerbes A, Ginès P, Wong F, Arroyo V.
Francesco
Salerno, Department of Internal Medicine, Policlinico IRCCS San Donato,
University of Milan, Via Morandi, 30, 20097 San Donato (MI), Italy.
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.
Hepatorenal syndrome (HRS) is a
serious complication of end-stage liver disease, occurring mainly in
patients with advanced cirrhosis and ascites, who have marked
circulatory dysfunction,1 as well as in patients with acute liver
failure.2 In spite of its functional nature, HRS is associated with a
poor prognosis,3 4 and the only effective treatment is liver
transplantation. During the 56th Meeting of the American Association
for the Study of Liver Diseases, the International Ascites Club held a
Focused Study Group (FSG) on HRS for the purpose of reporting the
results of an international workshop and to reach a consensus on a new
definition, criteria for diagnosis and recommendations on HRS
treatment.
A similar workshop was held in Chicago in 1994 in which
standardised nomenclature and diagnostic criteria for refractory
ascites and HRS were established.5 The introduction of innovative
treatments and improvements in our understanding of the pathogenesis of
HRS during the previous decade led to an increasing need to undertake a
new consensus meeting. This paper reports the scientific rationale
behind the new definitions and recommendations. The international
workshop included four issues debated by four panels of experts (see
Acknowledgements). The issues were: (1) evidence-based HRS
pathogenesis; (2) treatment of HRS using vasoconstrictors; (3) other
HRS treatments using transjugular intrahepatic portosystemic
stent-shunt (TIPS) and extracorporeal albumin dialysis (ECAD); and (4)
new definitions and diagnostic criteria for HRS and recommendations for
its treatment.
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