Management of Hepatorenal Syndrome: A Review

Overview

Journal J Clin Transl Hepatol

Specialty Gastroenterology

Date 2020 Aug 25

PMID 32832400

Citations 10

Authors

Raseen Tariq

Ashwani K Singal

Affiliations

Soon will be listed here.

Abstract

Acute kidney injury (AKI) occurs frequently in patients with cirrhosis, and hepatorenal syndrome (HRS) is second most common etiology of AKI after volume responsible pre-renal etiology. AKI in these patients negatively impacts pre- and post-transplant patient survival and healthcare burden. Reduced effective blood volume with consequent reduced renal blood flow, along with systemic inflammation in patients with decompensated cirrhosis, result in susceptibility to HRS. In this article, we will review updates over the last 5 years on the changing definition with diagnostic criteria and nomenclature of AKI and HRS, data on medical treatment with vasoconstrictors, and urinary biomarkers in diagnosis of etiology of AKI. We will also discuss the significance of liver transplantation evaluation once the diagnosis of HRS is established and the post-transplant immunosuppression management. We will also review one of the challenging issues that remains among transplant-eligible patients, that of allocation of simultaneous liver kidney transplant. Finally, we will review the new implemented policy from the Organ Procurement Transplant Network on simultaneous liver kidney allocation.

Citing Articles

Effects of Transjugular Intrahepatic Portosystemic Shunt on Renal and Pulmonary Function in Hepatic Decompensation with and without Hepatorenal and Hepatopulmonary Syndromes: A Review.

Abdelwahed A, Aboeldahb M, Wu G J Clin Transl Hepatol. 2024; 12(9):780-791.

PMID: 39280072 PMC: 11393845. DOI: 10.14218/JCTH.2024.00188.

Vasoconstrictor Therapy for Acute Kidney Injury Hepatorenal Syndrome: A Meta-Analysis of Randomized Studies.

Singal A, Palmer G, Melick L, Abdallah M, Kwo P Gastro Hep Adv. 2024; 2(4):455-464.

PMID: 39132033 PMC: 11308464. DOI: 10.1016/j.gastha.2023.01.007.

Association of non-selective β blockers with the development of renal dysfunction in liver cirrhosis: a systematic review and meta-analysis.

Xu X, Gao F, Wang T, Yang Z, Zhao Q, Qi X Ann Med. 2024; 56(1):2305935.

PMID: 38271554 PMC: 10812853. DOI: 10.1080/07853890.2024.2305935.

A Comprehensive Systematic Review of the Latest Management Strategies for Hepatorenal Syndrome: A Complicated Syndrome to Tackle.

Roy P, Minhaz N, Shah-Riar P, Simona S, Tasha T, Binte Hasan T Cureus. 2023; 15(8):e43073.

PMID: 37680416 PMC: 10481992. DOI: 10.7759/cureus.43073.

Long-term renal outcomes comparison between patients with chronic kidney disease and hepatorenal syndrome after living donor liver transplantation.

Tseng H, Lin Y, Lin C, Chen C, Yong C, Lin L Front Surg. 2023; 10:1116728.

PMID: 37077866 PMC: 10106629. DOI: 10.3389/fsurg.2023.1116728.

References

Mitchell M, Friedman L, McClain C . Medical Management of Severe Alcoholic Hepatitis: Expert Review from the Clinical Practice Updates Committee of the AGA Institute. Clin Gastroenterol Hepatol. 2016; 15(1):5-12. PMC: 5172399. DOI: 10.1016/j.cgh.2016.08.047. View

Angeli P, Garcia-Tsao G, Nadim M, Parikh C . News in pathophysiology, definition and classification of hepatorenal syndrome: A step beyond the International Club of Ascites (ICA) consensus document. J Hepatol. 2019; 71(4):811-822. DOI: 10.1016/j.jhep.2019.07.002. View

Singal A, Ong S, Satapathy S, Kamath P, Wiesner R . Simultaneous liver kidney transplantation. Transpl Int. 2018; 32(4):343-352. DOI: 10.1111/tri.13388. View

Barbano B, Sardo L, Gigante A, Gasperini M, Liberatori M, Giraldi G . Pathophysiology, diagnosis and clinical management of hepatorenal syndrome: from classic to new drugs. Curr Vasc Pharmacol. 2014; 12(1):125-35. DOI: 10.2174/157016111201140327163930. View

Keller F, Heinze H, Jochimsen F, Passfall J, Schuppan D, Buttner P . Risk factors and outcome of 107 patients with decompensated liver disease and acute renal failure (including 26 patients with hepatorenal syndrome): the role of hemodialysis. Ren Fail. 1995; 17(2):135-46. DOI: 10.3109/08860229509026250. View

Salerno F, Gerbes A, Gines P, Wong F, Arroyo V . Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Postgrad Med J. 2009; 84(998):662-70. DOI: 10.1136/gut.2006.107789. View

Gines A, Escorsell A, Gines P, Salo J, Jimenez W, Inglada L . Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gastroenterology. 1993; 105(1):229-36. DOI: 10.1016/0016-5085(93)90031-7. View

OLeary J, Levitsky J, Wong F, Nadim M, Charlton M, Kim W . Protecting the Kidney in Liver Transplant Candidates: Practice-Based Recommendations From the American Society of Transplantation Liver and Intestine Community of Practice. Am J Transplant. 2016; 16(9):2516-31. DOI: 10.1111/ajt.13790. View

Pawarode A, Fine D, Thuluvath P . Independent risk factors and natural history of renal dysfunction in liver transplant recipients. Liver Transpl. 2003; 9(7):741-7. DOI: 10.1053/jlts.2003.50113. View

10.

Sola E, Cardenas A, Gines P . Results of pretransplant treatment of hepatorenal syndrome with terlipressin. Curr Opin Organ Transplant. 2013; 18(3):265-70. DOI: 10.1097/MOT.0b013e3283614c7a. View

11.

Velidedeoglu E, CRAWFORD M, Desai N, Campos L, Abt P, Markmann J . Predictors of late kidney dysfunction post-liver transplantation. Transplant Proc. 2002; 34(8):3315-6. DOI: 10.1016/s0041-1345(02)03627-8. View

12.

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(7):680-5. DOI: 10.1097/MCG.0b013e318188947c. View

13.

Garcia-Tsao G, Parikh C, Viola A . Acute kidney injury in cirrhosis. Hepatology. 2008; 48(6):2064-77. DOI: 10.1002/hep.22605. View

14.

Cicinnati V, Yu Z, Klein C, Sotiropoulos G, Saner F, Malago M . Clinical trial: switch to combined mycophenolate mofetil and minimal dose calcineurin inhibitor in stable liver transplant patients--assessment of renal and allograft function, cardiovascular risk factors and immune monitoring. Aliment Pharmacol Ther. 2007; 26(9):1195-208. DOI: 10.1111/j.1365-2036.2007.03466.x. View

15.

Caregaro L, Menon F, Angeli P, Amodio P, Merkel C, Bortoluzzi A . Limitations of serum creatinine level and creatinine clearance as filtration markers in cirrhosis. Arch Intern Med. 1994; 154(2):201-5. View

16.

Sort P, Navasa M, Arroyo V, Aldeguer X, Planas R, Castells L . Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med. 1999; 341(6):403-9. DOI: 10.1056/NEJM199908053410603. View

17.

Fernandez J, Navasa M, Planas R, Montoliu S, Monfort D, Soriano G . Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis. Gastroenterology. 2007; 133(3):818-24. DOI: 10.1053/j.gastro.2007.06.065. View

18.

Terra C, Guevara M, Torre A, Gilabert R, Fernandez J, Martin-Llahi M . Renal failure in patients with cirrhosis and sepsis unrelated to spontaneous bacterial peritonitis: value of MELD score. Gastroenterology. 2005; 129(6):1944-53. DOI: 10.1053/j.gastro.2005.09.024. View

19.

Platz K, Mueller A, Blumhardt G, Bachmann S, Bechstein W, Kahl A . Nephrotoxicity following orthotopic liver transplantation. A comparison between cyclosporine and FK506. Transplantation. 1994; 58(2):170-8. View

20.

Singal A, Salameh H, Kuo Y, Wiesner R . Evolving frequency and outcomes of simultaneous liver kidney transplants based on liver disease etiology. Transplantation. 2014; 98(2):216-21. DOI: 10.1097/TP.0000000000000048. View