Hepatorenal syndrome and novel advances in its management

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Abstract

Hepatorenal syndrome is a complication of end stage liver disease. It is a unique form of functional renal failure related to kidney vasoconstriction in the absence of underlying kidney pathology. Hepatorenal syndrome is classified into 2 types: type-1 HRS shows a rapid and progressive decline in renal function with a very poor prognosis (median survival of about 2 weeks); type-2 HRS has a more stable kidney failure, with a median survival of 6 months; its main clinical manifestation is refractory ascites. The most appropriate therapy for HRS is liver transplantation but only a minority of HRS patients undergo the procedure due to the high mortality; survival among liver transplant recipients is lower in HRS than among their counterparts without HRS. A large body of evidence, based on observational studies and randomized controlled trials, has been accumulated in the last decade showing that terlipressin represents a milestone in the management of HRS. According to our meta-analysis of randomized trials comparing terlipressin vs. placebo (five trials, n=243 patients), the pooled rate of patients who reversed HRS by terlipressin was 8.09 (95% CI, 3.52; 18.59) (P

Original languageEnglish
Pages (from-to)588-601
Number of pages14
JournalKidney and Blood Pressure Research
Volume37
Issue number6
DOIs
Publication statusPublished - Dec 2013

Keywords

  • Cirrhosis
  • Hepatorenal syndrome
  • Survival
  • Terlipressin
  • Vasoconstrictors

ASJC Scopus subject areas

  • Nephrology
  • Cardiology and Cardiovascular Medicine

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