CHSJ

Curr Health Sci J, vol. 35, no. 1, 2009

Hepato-Renal Syndrome in Patients with Hepatic Cirrhosis

[Actualities]

Daniela Parvulescu(1), Maria Stoica(2)


(1)Department of Internal Medicine, County Emergency University Hospital, University of Medicine and Pharmacy, Craiova;
(2) Department of Anestesiology and Critical Care, County Emergency University Hospital, University of Medicine and Pharmacy, Craiova


Abstract:

Hepatorenal syndrome is a particular form of functional renal failure which may develop in patients with liver cirrhosis. Precise diagnostic criteria have been established to clearly define this entity, whereas recent advances in the understanding of the biology of vasoactive mediators and the physiology of microcirculation have allowed to better anticipate its pathophysiological mechanisms. During the course of cirrhosis, sinusoidal portal hypertension leads to splanchnic and systemic vasodilation, responsible for a reduction of effective arterial blood volume. As a result, a state of intense renal vasoconstriction develops, leading to renal failure in the absence of any organic renal disease. Innovative therapies have shown promise to prolong survival in patients with hepatorenal syndrome, including the administration of analogs of vasopressin, the insertion of transjugular intrahepatic portosystemic shunts. On a preventive viewpoint, several simple measures have been shown to reduce the risk of hepatorenal syndrome in cirrhotic patients including the appropriate use of diuretics, the avoidance of nephrotoxic drugs, the prophylaxis of spontaneaous bacterial peritonitis and optimal fluid management in patients undergoing large volume paracentesis.


Keywords: hepatorenal syndrome, cirrhosis, renal failure, pathophysiology, treatment, prevention



Corresponding: Daniela Parvulescu, MD, Department of Internal Medicine, County Emergency University Hospital, University of Medicine and Pharmacy, Craiova


DOI 10.12865/CHSJ.35.01.13 - Download PDF
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