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The Renal Failure in HRS is thought to result from Renin-angiotensin-aldosterone System (RAAS) and Sympathetic Nervous System (SNS) activation. Kidneys that are normal typically resume functioning following a successful Liver Transplantation .

It is estimated that 40% of patients with Cirrhosis and Ascites , which are stigmata of Chronic Liver Disease , will develop HRS during the course of their disease.

HRS classified in to Type I HRS and Type 2 HRS
  • Type I HRS is associated with Spontaneous Bacterial Peritonitis . Median survival of Type I HRS, without treatment, is less than two weeks.

  • Type II HRS is characterized by relatively stable hepatic function. Survival in Type II HRS is typically 3-6 months.



Treatment

Acute treatment involves maintaining the Blood Pressure . Several Vasoactive Agent s, including Terlipressin , Midodrine and Norepinephrine , have shown some benefit. These agents should be given concomitantly with intravenous infusion of Albumin . If the patient is taking Diuretic s, they should be discontinued.

The definitive treatment for HRS is Mitzner SR, Stange J, Klammt S, Risler T, Erley CM, Bader BD, Berger ED, Lauchart W, Peszynski P, Freytag J, Hickstein H, Loock J, Lohr JM, Liebe S, Emmrich J, Korten G, Schmidt R. Improvement of hepatorenal syndrome with extracorporeal albumin dialysis MARS: results of a prospective, randomized, controlled clinical trial. Liver Transpl. 2000 May;6(3):277-86. PMID 10827226. have shown some promise for HRS patients.


REFERENCES



EXTERNAL LINK

Hepatorenal syndrome - emedicine.com article