• Matjaž Hafner Klinični oddelek za gastroenterologijo Klinični center Japljeva ul. 2 1525 Ljubljana
Keywords: advanced liver disease, arterial circulatory abnormalities, renal failure, diagnostic criteria, liver transplantation


Background. Hepatorenal syndrome (HRS) is a

common complication of advanced hepatic disease characterized

by marked abnormalities in arterial circulation and by

renal failure. An extreme arteriolar vasodilatation located in

the splanchnic circulation results in a reduction of total systemic

vascular resistence and arterial hypotension. Vasoconstriction

occurs in the renal circulation as in all other extrasplanchnic

vascular territories. In the kidney, marked renal

vasoconstriction results in a low glomerular filtration rate.

Conclusions. The diagnosis of HRS is currently based on exclusion

of other causes of renal failure. Prognosis of patients

with HRS is very poor. Liver transplantation is the best therapeutic

option, but it is seldom applicable due to the short survival

expectancy of most patients with HRS, particularly those

with the rapidly progressive type of HRS. New therapies developed

during the last few years, such as the use of systemic

vasoconstrictors or transjugular intrahepatic portosystemic

shunts (TIPS) appear promising. Such treatments are of interest

not only as a bridge to liver transplantation but also as a

therapy for patients who are not candidates for transplantation.


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Arroyo V, Gines P, Gerbes AL et al. Definition and diagnostic criteria of

refractory ascites and hepatorenal syndrome in cirrhosis. Hepatology 1996;

: 164–76.

Gines P, Schrier RW. Hepatorenal syndrome and renal dysfunction associated

with liver disease. In: Schrier RW, Gottschalk CW eds. Diseases of the

kidney, 6th ed. Boston: Little Brown and Company, 1997; 2099–127.

Schrier RW, Arroyo V, Bernardi M et al. Peripheral arterial vasodilatation

hypothesis: a proposal for the initiation of renal sodium and water retention

in cirrhosis. Hepatology 1988; 8: 1151–7.

Schrier RW, Neiderberger M, Weigert A, Gines P. Peripheral arterial vasodilatation:

determinant of functional spectrum of cirrhosis. Semin Liver Dis

; 14: 14–22.

Abelman WH. Hyperdynamic circulation in cirrhosis: a historical perspective.

Hepatology 1994; 20: 1356–8.

Gines P, Schrier RW. The arterial vasodilatation hypothesis of ascites formation.

In: Arroyo V, Gines P, Rodes J, Schrier RW eds. Ascites and renal

dysfunction in liver disease. Pathogenesis, diagnosis and treatment. Malden:

Blackwell Science, 1999; 411–30.

Martin PY, Gines P, Schrier RW. Nitric oxide as a mediator of hemodynamic

abnormalities and sodium and water retention in cirrhosis. N Engl J Med

; 339: 533–41.

Bosch J, Garcia-Pagan JC. The splanhnic circulation in cirrhosis. In: Arroyo

V, Gines P, Rodes J, Schrier RW eds. Ascites and renal dysfunction in liver

disease. Pathogenesis, diagnosis and treatment. Malden: Blackwell Science,

; 330–50.

Moller S, Gulberg V, Henriksen JH, Gerbes AL. Endothelin-1 and endothelin-

in cirrhosis: Relation to systemic and splanhnichaemodynamics. J Hepatol

; 23: 135–44.

Henriksen JH. Cirrhosis: ascites and hepatorenal syndrome; recent advances

in pathogenesis. J Hepatol 1995; 23: Suppl 1: 25–30.

Wong PY, Caroll RE, Lipinsky TL, Capone RR. Studies on the renin-angiotensin-

aldosterone system in patients with cirrhosis and ascites: results of saline

and albumin infusion. Gastroenterology 1979; 77: 1171–6.

Moore K, Ward PS, Taylor GW, Williams R. Systemic and renal production

of thromboxane A2 and prostacyclin in decompensated liver disease and

hepatorenal syndrome. Gastroenterology 1991; 100: 1069–77.

Mirouze D, Zipser RD, Reynolds TB. Effect of inhibitors of prostaglandin

synthesis on induced diuresis in cirrhosis. Hepatology 1983; 3: 50–5.

Arieff AI, Chidsey CA. Renal function in cirrhosis and the effect of prostaglandin

A1. Am J Med 1974; 56: 695–703.

Bataller R, Gines P, Guevara M, Arroyo V. Hepatorenal syndrome. Semin Liv

Dis 1997; 3: 233–46.

Follo A, Llovet JM, Navasa M et al. Renal impairment after spontaneous

bacterial peritonitis in cirrhosis: incidence, clinical course, predictive factors

and prognosis. Hepatology 1994; 20: 1495–501.

Navasa M, Follo A, Filella X et al. Tumor necrosis factor and interleukin-6 in

spontaneous bacterial peritonitis: relationship with the development of

renal impairment and mortality. Hepatology 1998; 20: 819–24.

Arroyo V, Sort P, Gines P, Planas R. Treatment of ascites by paracentesis. In:

Arroyo V, Gines P, Rodes J, Schrier RW eds. Ascites and renal dysfunction in

liver disease. Pathogenesis, diagnosis and treatment. Malden: Blackwell

Science, 1999; 463–79.

Gines P, Tito LI, Arroyo V et al. Randomized comparative study of therapeutic

paracentesis with and without intravenous albumin in cirrhosis. Gastroenterology

; 84: 1493–502.

Arroyo V, Bataller R, Guevara M. Treatment of hepatorenal syndrome in

cirrhosis. In: Arroyo V, Gines P, Rodes J, Schrier RW eds. Ascites and renal

dysfunction in liver disease. Pathogenesis, diagnosis and treatment. Malden:

Blackwell Science, 1999: 522–37.

Barnardo E, Baldus WP, Maher FT. Effects of dopamine on renal function in

patients with cirrhosis. Gastroenterology 1970; 58: 524–31.

Lenz K, Hornatgl H, Druml W et al. Ornipressin in the treatment of functional

renal failure in decompensated liver cirrhosis. Gastroenterology 1991;

: 1060–7.

Gulberg V, Bilzer M, Gerbes AL. Ornipressin for treatment of hepatorenal

syndrome (HRS) type I: Results of long-term therapy or retreatment. Hepatology

; 30: 870–5.

Ganne-Carrie N, Hadengue A, Mathurin P, Durand F, Erlinger S, Benhamou

JP. Hepatorenal syndrome: Long-term treatment with terlipressin as a

bridge to liver transplantation. Dig Dis Sci 1996; 41: 1054–6.

Uriz J, Gines P, Cardenas A et al. Terlipressin plus albumin infusion: An

effective and safe therapy of hepatorenal syndrome. J Hepatol 2000; 33: 43–

Guevara M, Gines P, Bandi JC et al. Transjugular intrahepatic portosystemic

shunt in hepatorenal syndrome. Effects on renal function and vasoactive

systems. Hepatology 1998; 27: 416–22.

Sturgis TM. Hepatorenal syndrome: Resolution after transjugular intrahepatic

portosystemic shunt. J Clin Gastroenterol 1995; 20: 241–3.

Brensing KA, Textor J, Perz J et al. Long term outcome after transjugular

intrahepatic portosystemic stent-shunt in non–transplant cirrhotics with

hepatorenal syndrome: a phase II study. Gut 2000; 47: 288–95.

Epstein M, Perez GO, Bedoya LA et al. Continuous arterio-venous ultrafiltration

in cirrhotic patients with ascites or renal failure. Int J Artif Organs 1986;

: 253–6.

Epstein M. Hepatorenal syndrome: Emerging perspectives. Semin Nephrol

; 17: 563–75.

Running TC, Brown MR, Swygert TH et al. Perioperative renal function in

patients undergoing orthotopic liver transplantation. Transplantation 1991;

: 422–7.

Rimola A, Gavaler JS, Schade RR et al. Effects of renal impairment on liver

transplantation. Gastroenterology 1987; 93: 148–56.

Gonwa TA, Morris CA, Goldstein RM et al. Long term survival and renal

function following liver transplantation in patients with and without hepatorenal

syndrome – experience in 300 patients. Transplantation 1991; 51:


Gonwa TA, Klintmalm GB, Jennings LS et al. Impact of pretransplant renal

function on survival after liver transplantation. Transplantation 1995; 59:


Sort P, Navasa M, Arroyo V et al. Effect of intravenous albumin on renal

impairment and mortality in patients with cirrhosis and spontaneous bacterial

peritonitis. N Engl J Med 1999; 341: 403–9.

How to Cite
Hafner M. HEPATORENAL SYNDROME. ZdravVestn [Internet]. 1 [cited 23Aug.2019];70(12). Available from: https://vestnik.szd.si/index.php/ZdravVest/article/view/2608