HEPATORENALT SYNDROM-Hva vet vi om det?

Abstract Objective: Hepatorenal syndrome (HRS) is a life-threatening complication of end-stage liver disease. Better knowledge of the disease may contribute to targeted and quick diagnosis and effective treatment of those affected. In the present paper, an overview of hepatorenal syndrome is presented, including the most recent advances in pathophysiology; as well as diagnostic, clinical and therapeutic aspects. Methods: Review of literature presented over the last 10 years by searching through the PubMed and Cochrane databases using the terms “hepatorenal syndrome”, “cirrhosis AND acute renal failure” ,” cirrhosis AND hepatorenal syndrome". I have also looked over some review-articles that were most frequently cited by other authors. Results and conclusion: HRS is best described as an acute functional kidney failure (AKI), resulting from severe impairment in systemic circulatory function seen in the advanced stages of cirrhosis. The pathophysiological hallmark is intense renal vasoconstriction, which traditionally has been considered to be the consequence of the extreme splanchnic arterial vasodilatation occurring in these patients. However, recent data indicate that a reduction in cardiac output also plays a significant role, and that HRS in cirrhosis is a complex syndrome that affects organs other than the kidney. HRS is a diagnosis of exclusion and all other causes of acute renal failure have to be considered and ruled out. Despite its functional nature, the prognosis is very poor. The most recent advances in the understanding of the pathophysiology of HRS are the basis of the new therapeutic interventions. Until recently, liver transplantation was the only viable option for treatment. More recently, several studies have been performed to unravel newer promising treatment modalities. Combined use of vasoconstrictors and albumin can act as bridges to early liver transplantation (or combined liver-kidney transplantation in selected patients). However, further research is necessary to determine its clinical usefulness