Sao Paulo Medical Journal
Print version ISSN 1516-3180
On-line version ISSN 1806-9460
GENZINI, Tércio and TORRICELLI, Fábio César Miranda. Hepatorenal syndrome: an update. Sao Paulo Med. J. [online]. 2007, vol.125, n.1, pp.50-56. ISSN 1516-3180. http://dx.doi.org/10.1590/S1516-31802007000100010.
Hepatorenal syndrome (HRS) is the development of renal failure in patients with chronic previous liver disease, without clinical or laboratory evidence of previous kidney disease. It affects up to 18% of cirrhotic patients with ascites during the first year of follow-up, reaching 39% in five years and presenting a survival of about two weeks after its establishment. HRS diagnosis is based on clinical and laboratory data. The occurrence of this syndrome is related to the mechanism for ascites development, involving vasoconstriction, low renal perfusion, water and sodium retention, increased plasma volume, and consequent overflow at the splanchnic level. Renal vasoactive mediators like endothelin 1, thromboxane A2, and leukotrienes are also involved in the genesis of this syndrome, which culminates in functional renal insufficiency. The treatment of choice can be pharmacological or surgical, although liver transplantation is the only permanent and effective treatment, with a four-year survival rate of up to 60%. Liver function recovery is usually followed by renal failure reversion. Early diagnosis and timely therapeutics can increase life expectancy for these patients while they are waiting for liver transplantation as a definitive treatment.
Keywords : Hepatorenal syndrome; Renal insufficiency; Liver cirrhosis; Portal hypertension; Vasoconstrictor agents.