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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