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Diagnosis, prevention and treatment of the hepatorenal syndrome in cirrhosis. A consensus workshop of the international ascites club.
  1. Francesco Salerno (francesco.salerno{at}unimi.it)
  1. University of Milan, Italy
    1. Alexander Gerbes (gerbes{at}med.uni-muenchen.de)
    1. Department of Internal Medicine, Germany
      1. Pere Gines (pgines{at}clinic.ub.es)
      1. Liver Unit, Hospital Clinic of Barcelona, Spain
        1. Florence Wong (florence.wong{at}utoronto.ca)
        1. Toronto Hospital, Canada
          1. Vicente Arroyo (varroyo{at}clinic.ub.es)
          1. Liver Unit, Hospital Clinic of Barcelona, Spain

            Abstract

            Hepatorenal syndrome (HRS) is a functional renal failure that occurs in patients with cirrhosis, ascites, and liver failure, as well as in patients with acute liver failure or alcoholic hepatitis. HRS is diagnosed by exclusion of other known causes or renal failure. It is characterized by impaired renal function, marked alterations in cardiovascular function, and over-activity in the endogenous vasoactive systems.

            Type-2 HRS is the result of spontaneous progression of the circulatory dysfunction in cirrhosis, which is mainly caused by increased splanchnic vasodilation. It is characterized by moderate slowly evolving renal failure and is frequently associated with refractory ascites.

            Type-1 HRS is caused by acute and severe impairment of circulatory function related to marked peripheral vasodilation in the presence of relatively low and insufficient cardiac output. Renal failure is often rapidly progressive, with a poor short term survival, and rapid deterioration of liver function, and hepatic encephalopathy.

            Type-1 HRS may occur after a precipitating event, such as spontaneous bacterial peritonitis (SBP), and may be prevented by antibiotics and infusion of albumin. "Renal function may improve in patients with type-1 HRS following the administration of vasoconstrictors (terlipressin, midodrine, or norepinephrine) plus albumin, or by transjugular intrahepatic portosystemic shunt (TIPS). However, liver transplantation is the only treatment that provides long-term survival.

            Although vasoconstrictors plus albumin and TIPS can reverse type-2 HRS, further randomized controlled trials are required to determine whether or not their use is effective.

            • TIPS
            • albumin
            • liver transplantation
            • midodrine
            • terlipressin

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