HEPATORENAL SYNDROME: UPDATE
Main Article Content
Keywords
Hepatorenal syndrome, liver cirrhosis, acute kidney injury, diagnosis, treatment
Abstract
Hepatorenal syndrome is kidney dysfunction due to a decrease in renal flow secondary to chronic liver disease such as liver cirrhosis or acute liver disease. Causing a decrease in the glomerular filtration. In the classification there are two types recognized, AKI, which is characterized by a rapid and progressive deterioration of kidney function, and Non-AKI, by a slow deterioration, but with a better prognosis. This pathology represents a high mortality rate, so timely diagnosis will be key to successful treatment.
General objective: To describe the updates in the diagnostic criteria and treatments of hepatorenal syndrome.
Methods: A narrative literature review was conducted using Science direct, Pubmed, Springer, Scielo/Redalyc and Scopus databases. Scientific articles published during the period 2018-2023 in Spanish and English were included. Likewise, articles that are in indexed journals and ranked in quartiles according to the SJR (Scimago Institutions Rankins) were selected.
Results: After the results obtained from the literature reviews, there are no specific clinical findings, however, clinical manifestations reflect an underlying advanced liver disease, acute renal injury and circulatory abnormalities.
Conclusions: it is essential to add Doppler ultrasound studies to the clinical manifestations for the diagnosis, for a comprehensive management in the patient, the optimal treatment is liver transplantation, but it is not always viable, therefore, the pharmacological treatment of vasoconstrictors and albumin is used.
References
1. Amador AC, Rodríguez LJV, Hernández G, Aguilar DPS, Córdoba PAB, Muñoz JLR, et al. Hepatorenal syndrome: a review of the literature. Rev Colomb Nefrol. February 21, 2022; 9(1):E539-E539.
2. Subedi A, Kumar VCS, Subedi AS, Sapkota B, Subedi A, Kumar V, et al. A Review of Hepatorenal Syndrome. Cureus [Internet]. July 1, 2021; 13(7). Available in: https://www.cureus.com/articles/63880-a-review-of-hepatorenal-syndrome
3. Nassar M, Nso N, Medina L, Ghernautan V, Novikov A, El-Ijla A, et al. Liver kidney crosstalk: Hepatorenal syndrome. World J Hepatol. September 27, 2021; 13(9):1058-68.
4. Ojeda-Yuren AS, Cerda-Reyes E, Herrero-Maceda MR, Castro-Narro G, Piano S. An Integrated Review of the Hepatorenal Syndrome. Ann Hepatol. 2021 May 1;10:100236 PM.
5. Ospina LLG, Laverde JLG, Tapia JAA, Cahuasquí JPO. Hyponatremia and hepatorenal syndrome. RECIMUNDO. July 11, 2020; 4(3):102-17.
6. Chaney A. A Review for the Practicing Clinician: Hepatorenal Syndrome, a Form of Acute Kidney Injury, in Patients with Cirrhosis. Clin Exp Gastroenterol. 2021 Oct 5;14:385-96.
7. Gupta K, Bhurwal A, Law C, Ventre S, Minacapelli CD, Kabaria S, et al. Acute kidney injury and hepatorenal syndrome in cirrhosis. World J Gastroenterol. July 14, 2021; 27(26):3984-4003.
8. Simbrunner B, Trauner M, Reiberger T, Mandorfer M. Recent advances in the understanding and management of hepatorenal syndrome. Fac Rev. 2021 May 21;10:48 AM.
9. Saner FH, Canbay A, Gerken G, Broelsch CE. Pharmacology, clinical efficacy and safety of terlipressin in esophageal varicose veins bleeding, septic shock and hepatorenal syndrome. Expert Rev Gastroenterol Hepatol. December 2007; 1(2):207-17.
10. Flamm SL, Brown K, Wadei HM, Brown RS, Kugelmas M, Samaniego‐Picota M, et al. The Current Management of Hepatorenal Syndrome–Acute Kidney Injury in the United States and the Potential of Terlipressin. Liver Transpl. August 2021; 27(8):1191-202.
11. Moore K, Jamil K, Verleger K, Luo L, Kebede N, Heisen M, et al. Real‐world treatment patterns and outcomes using terlipressin in 203 patients with the hepatorenal syndrome. Aliment Pharmacol Ther. July 2020; 52(2):351-8.
12. Habas E, Ibrahim AR, Moursi MO, Shraim BA, Elgamal ME, Elzouki AN. Update on hepatorenal Syndrome: Definition, Pathogenesis, and management. Arab J Gastroenterol. May 1, 2022; 23(2):125-33.
13. Amin AA, Alabsawy EI, Jalan R, Davenport A. Epidemiology, Pathophysiology, and Management of Hepatorenal Syndrome. Semin Nephrol. January 1, 2019; 39(1):17-30.
14. Kaewput W, Thongprayoon C, Dumancas CY, Kanduri SR, Kovvuru K, Kaewput C, et al. In-hospital mortality of hepatorenal syndrome in the United States: Nationwide inpatient sample. World J Gastroenterol. December 7, 2021; 27(45):7831-43.
15. Francoz C, Durand F, Kahn JA, Genyk YS, Nadim MK. Hepatorenal Syndrome. Clin J Am Soc Nephrol. May 2019; 14(5):774.
16. Tangpanithandee S, Thongprayoon C, Krisanapan P, Mao MA, Kaewput W, Pattharanitima P, et al. Distinct Subtypes of Hepatorenal Syndrome and Associated Outcomes as Identified by Machine Learning Consensus Clustering. Diseases. March 2023; 11(1):18.
17. Tariq R, Singal AK. Management of Hepatorenal Syndrome: A Review. J Clin Transl Hepatol. June 28, 2020; 8(2):192-9.
18. Facciorusso A. Hepatorenal Syndrome Type 1: Current Challenges And Future Prospects. Ther Clin Risk Manag. 2019 Nov 27;15:1383-91.
19. Hasan I, Rashid T, Chirila RM, Ghali P, Wadei HM. Hepatorenal syndrome: pathophysiology and evidence-based management update. Rom J Intern Med. Aug. 31, 2021; 59(3):227-61.
20. Sheng XY, Lin FY, Wu J, Cao HC. Development and validation of a prognostic model for patients with hepatorenal syndrome: A retrospective cohort study. World J Gastroenterol. May 28, 2021; 27(20):2615-29.
21. Fida S, Khurshid SMS, Mansoor H, Fida S, Khurshid SMS, Mansoor H. Frequency of Hepatorenal Syndrome Among Patients With Cirrhosis and Outcome After Treatment. Cureus. August 25, 2020; 12(8). Available in: https://www.cureus.com/articles/39160-frequency-of-hepatorenal-syndrome-among-patients-with-cirrhosis-and-outcome-after-treatment
22. Wang S, Zhou Z, Xu C, Chen H, Ren W, Yang X, et al. Establishment and evaluation of an early prediction model of hepatorenal syndrome in patients with decompensated hepatitis B cirrhosis. BMC Gastroenterol. January 2, 2023; 23(1):1.
23. Giraldo C, Jiménez M, Torres J. Hepatorenal syndrome in acute on chronic liver failure. Rev. Colom. Nefrol. 2022; 8(2). Available in: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S2500-50062021000200704&lang=es
24. Angeli P, Garcia-Tsap G, Nadim M, Parikh C. News in pathophysiology, definition and classification of hepatorenal syndrome: A step beyond the International Club of Ascites (ICA) consensus document. J Hepatol. October 1, 2019; 71(4):811-22.
25. Sherif M, Rahman S, Abd S, Elkholy S, Abd N, Ak-Jarhi U, Awad A. Role of renal Duplex ultrasonography in evaluation of hepatorenal syndrome | Egyptian Liver Journal. 2023; 11 (34). . Available in: https://eglj.springeropen.com/articles/10.1186/s43066-021-00104-9
26. Facciorusso A. Hepatorenal Syndrome Type 1: Current Challenges And Future Prospects. Therapeutics and Clinical Risk Management. 2023; 15: 1383-1391. Available in: https://www-tandfonline-com.vpn.ucacue.edu.ec/doi/full/10.2147/TCRM.S205328
27. Kulkarni AV, Ravikumar ST, Tevethia H, Premkumar M, Kumar K, Sharma M, et al. Safety and efficacy of terlipressin in acute-on-chronic liver failure with hepatorenal syndrome-acute kidney injury (HRS-AKI): a prospective cohort study. Sci Rep. 2022 Apr 1;12:5503.
28. Wang H, Liu A, Bo W, Feng X, Hu Y. Terlipressin in the treatment of hepatorenal syndrome: A systematic review and meta-analysis. Medicine (Baltimore). April 2018; 97(16):E0431.
29. Nguyen-Tat M, Jäger J, Rey JW, Nagel M, Labenz C, Wörns MA, et al. Terlipressin and albumin combination treatment in patients with hepatorenal syndrome type 2. United Eur Gastroenterol J. May 1, 2019; 7(4):529-37.
30. Fernández J, Navasa M, Planas R, Montoliu S, Monfort D, Soriano G, et al. Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis. Gastroenterology. September 2007; 133(3):818-24.
31. Bosch J. Small diameter shunts should lead to safe expansion of the use of TIPS. J Hepatol. January 2021; 74(1):230-4.
32. Garcia-Pagán JC, Saffo S, Mandorfer M, Garcia-Tsao G. Where does TIPS fit in the management of patients with cirrhosis? JHEP Rep. May 23, 2020; 2(4):100122.
33. Praktiknjo M, Abu-Omar J, Chang J, Thomas D, Jansen C, Kupczyk P, et al. Controlled underdilation using novel VIATORR® controlled expansion stents improves survival after transjugular intrahepatic portosystemic shunt implantation. JHEP Rep. March 3, 2021; 3(3):100264.
34. Allegretti AS, Parada XV, Eneanya ND, Gilligan H, Xu D, Zhao S, et al. Prognosis of Patients with Cirrhosis and AKI Who Initiate RRT. Clin J Am Soc Nephrol CJASN. January 6, 2018; 13(1):16-25.
35. Piano S, Gambino C, Vettore E, Calvino V, Tonon M, Boccagni P, et al. Response to Terlipressin and Albumin Is Associated With Improved Liver Transplant Outcomes in Patients With Hepatorenal Syndrome. Hepatol Baltim, Md., May 2021; 73(5):1909-19.
36. Analysis of Survival Benefits of Living Versus Deceased Donor Liver Transplant in High Model for End‐Stage Liver Disease and Hepatorenal Syndrome - Wong - 2021 - Hepatology - Wiley Online Library. Available in: https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/hep.31584
37. Lavayssière L, Kallab S, Cardeau-Desangles I, Nogier MB, Cointault O, Barange K, et al. Impact of molecular adsorbent recirculating system on renal recovery in type-1 hepatorenal syndrome patients with chronic liver failure. J Gastroenterol Hepatol. June 2013; 28(6):1019-24.
38. Bañares R, Nevens F, Larsen FS, Jalan R, Albillos A, Dollinger M, et al. Extracorporeal albumin dialysis with the molecular adsorbent recirculating system in acute-on-chronic liver failure: the RELIEF trial. Hepatol Baltim, Md., March 2013; 57(3):1153-62.
39. Torre A, Martín-Llahí M, Ginès P. Dilutional hyponatremia, refractory ascites and hepatorenal syndrome: current treatment. Gastroenterol Hepatol. 2004 Oct;27:26-39.
40. Kaptein EM, Oo Z, Kaptein MJ. Hepatorenal syndrome misdiagnosis may be reduced using inferior vena cava ultrasound to assess intravascular volume and guide management. Ren Fail. December 31, 2023; 45(1):2185468.
41. Wang L, Long Y, Li KX, Xu GS. Pharmacological treatment of hepatorenal syndrome: a network meta-analysis. Gastroenterol Rep. April 1, 2020; 8(2):111-8.
42. Velez JCQ, Karakala N, Tayebi K, Wickman TJ, Mohamed MMB, Kovacic RA, et al. Responsiveness to Vasoconstrictor Therapy in Hepatorenal Syndrome Type 1. Kidney360. April 2023; 4(4):E448.
43. Tseng HY, Lin YH, Lin CC, Chen CL, Yong CC, Lin LM, et al. Long-term renal outcomes comparison between patients with chronic kidney disease and hepatorenal syndrome after living donor liver transplantation. Front Surg. 2023;10. Available in: https://www.frontiersin.org/articles/10.3389/fsurg.2023.1116728
2. Subedi A, Kumar VCS, Subedi AS, Sapkota B, Subedi A, Kumar V, et al. A Review of Hepatorenal Syndrome. Cureus [Internet]. July 1, 2021; 13(7). Available in: https://www.cureus.com/articles/63880-a-review-of-hepatorenal-syndrome
3. Nassar M, Nso N, Medina L, Ghernautan V, Novikov A, El-Ijla A, et al. Liver kidney crosstalk: Hepatorenal syndrome. World J Hepatol. September 27, 2021; 13(9):1058-68.
4. Ojeda-Yuren AS, Cerda-Reyes E, Herrero-Maceda MR, Castro-Narro G, Piano S. An Integrated Review of the Hepatorenal Syndrome. Ann Hepatol. 2021 May 1;10:100236 PM.
5. Ospina LLG, Laverde JLG, Tapia JAA, Cahuasquí JPO. Hyponatremia and hepatorenal syndrome. RECIMUNDO. July 11, 2020; 4(3):102-17.
6. Chaney A. A Review for the Practicing Clinician: Hepatorenal Syndrome, a Form of Acute Kidney Injury, in Patients with Cirrhosis. Clin Exp Gastroenterol. 2021 Oct 5;14:385-96.
7. Gupta K, Bhurwal A, Law C, Ventre S, Minacapelli CD, Kabaria S, et al. Acute kidney injury and hepatorenal syndrome in cirrhosis. World J Gastroenterol. July 14, 2021; 27(26):3984-4003.
8. Simbrunner B, Trauner M, Reiberger T, Mandorfer M. Recent advances in the understanding and management of hepatorenal syndrome. Fac Rev. 2021 May 21;10:48 AM.
9. Saner FH, Canbay A, Gerken G, Broelsch CE. Pharmacology, clinical efficacy and safety of terlipressin in esophageal varicose veins bleeding, septic shock and hepatorenal syndrome. Expert Rev Gastroenterol Hepatol. December 2007; 1(2):207-17.
10. Flamm SL, Brown K, Wadei HM, Brown RS, Kugelmas M, Samaniego‐Picota M, et al. The Current Management of Hepatorenal Syndrome–Acute Kidney Injury in the United States and the Potential of Terlipressin. Liver Transpl. August 2021; 27(8):1191-202.
11. Moore K, Jamil K, Verleger K, Luo L, Kebede N, Heisen M, et al. Real‐world treatment patterns and outcomes using terlipressin in 203 patients with the hepatorenal syndrome. Aliment Pharmacol Ther. July 2020; 52(2):351-8.
12. Habas E, Ibrahim AR, Moursi MO, Shraim BA, Elgamal ME, Elzouki AN. Update on hepatorenal Syndrome: Definition, Pathogenesis, and management. Arab J Gastroenterol. May 1, 2022; 23(2):125-33.
13. Amin AA, Alabsawy EI, Jalan R, Davenport A. Epidemiology, Pathophysiology, and Management of Hepatorenal Syndrome. Semin Nephrol. January 1, 2019; 39(1):17-30.
14. Kaewput W, Thongprayoon C, Dumancas CY, Kanduri SR, Kovvuru K, Kaewput C, et al. In-hospital mortality of hepatorenal syndrome in the United States: Nationwide inpatient sample. World J Gastroenterol. December 7, 2021; 27(45):7831-43.
15. Francoz C, Durand F, Kahn JA, Genyk YS, Nadim MK. Hepatorenal Syndrome. Clin J Am Soc Nephrol. May 2019; 14(5):774.
16. Tangpanithandee S, Thongprayoon C, Krisanapan P, Mao MA, Kaewput W, Pattharanitima P, et al. Distinct Subtypes of Hepatorenal Syndrome and Associated Outcomes as Identified by Machine Learning Consensus Clustering. Diseases. March 2023; 11(1):18.
17. Tariq R, Singal AK. Management of Hepatorenal Syndrome: A Review. J Clin Transl Hepatol. June 28, 2020; 8(2):192-9.
18. Facciorusso A. Hepatorenal Syndrome Type 1: Current Challenges And Future Prospects. Ther Clin Risk Manag. 2019 Nov 27;15:1383-91.
19. Hasan I, Rashid T, Chirila RM, Ghali P, Wadei HM. Hepatorenal syndrome: pathophysiology and evidence-based management update. Rom J Intern Med. Aug. 31, 2021; 59(3):227-61.
20. Sheng XY, Lin FY, Wu J, Cao HC. Development and validation of a prognostic model for patients with hepatorenal syndrome: A retrospective cohort study. World J Gastroenterol. May 28, 2021; 27(20):2615-29.
21. Fida S, Khurshid SMS, Mansoor H, Fida S, Khurshid SMS, Mansoor H. Frequency of Hepatorenal Syndrome Among Patients With Cirrhosis and Outcome After Treatment. Cureus. August 25, 2020; 12(8). Available in: https://www.cureus.com/articles/39160-frequency-of-hepatorenal-syndrome-among-patients-with-cirrhosis-and-outcome-after-treatment
22. Wang S, Zhou Z, Xu C, Chen H, Ren W, Yang X, et al. Establishment and evaluation of an early prediction model of hepatorenal syndrome in patients with decompensated hepatitis B cirrhosis. BMC Gastroenterol. January 2, 2023; 23(1):1.
23. Giraldo C, Jiménez M, Torres J. Hepatorenal syndrome in acute on chronic liver failure. Rev. Colom. Nefrol. 2022; 8(2). Available in: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S2500-50062021000200704&lang=es
24. Angeli P, Garcia-Tsap G, Nadim M, Parikh C. News in pathophysiology, definition and classification of hepatorenal syndrome: A step beyond the International Club of Ascites (ICA) consensus document. J Hepatol. October 1, 2019; 71(4):811-22.
25. Sherif M, Rahman S, Abd S, Elkholy S, Abd N, Ak-Jarhi U, Awad A. Role of renal Duplex ultrasonography in evaluation of hepatorenal syndrome | Egyptian Liver Journal. 2023; 11 (34). . Available in: https://eglj.springeropen.com/articles/10.1186/s43066-021-00104-9
26. Facciorusso A. Hepatorenal Syndrome Type 1: Current Challenges And Future Prospects. Therapeutics and Clinical Risk Management. 2023; 15: 1383-1391. Available in: https://www-tandfonline-com.vpn.ucacue.edu.ec/doi/full/10.2147/TCRM.S205328
27. Kulkarni AV, Ravikumar ST, Tevethia H, Premkumar M, Kumar K, Sharma M, et al. Safety and efficacy of terlipressin in acute-on-chronic liver failure with hepatorenal syndrome-acute kidney injury (HRS-AKI): a prospective cohort study. Sci Rep. 2022 Apr 1;12:5503.
28. Wang H, Liu A, Bo W, Feng X, Hu Y. Terlipressin in the treatment of hepatorenal syndrome: A systematic review and meta-analysis. Medicine (Baltimore). April 2018; 97(16):E0431.
29. Nguyen-Tat M, Jäger J, Rey JW, Nagel M, Labenz C, Wörns MA, et al. Terlipressin and albumin combination treatment in patients with hepatorenal syndrome type 2. United Eur Gastroenterol J. May 1, 2019; 7(4):529-37.
30. Fernández J, Navasa M, Planas R, Montoliu S, Monfort D, Soriano G, et al. Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis. Gastroenterology. September 2007; 133(3):818-24.
31. Bosch J. Small diameter shunts should lead to safe expansion of the use of TIPS. J Hepatol. January 2021; 74(1):230-4.
32. Garcia-Pagán JC, Saffo S, Mandorfer M, Garcia-Tsao G. Where does TIPS fit in the management of patients with cirrhosis? JHEP Rep. May 23, 2020; 2(4):100122.
33. Praktiknjo M, Abu-Omar J, Chang J, Thomas D, Jansen C, Kupczyk P, et al. Controlled underdilation using novel VIATORR® controlled expansion stents improves survival after transjugular intrahepatic portosystemic shunt implantation. JHEP Rep. March 3, 2021; 3(3):100264.
34. Allegretti AS, Parada XV, Eneanya ND, Gilligan H, Xu D, Zhao S, et al. Prognosis of Patients with Cirrhosis and AKI Who Initiate RRT. Clin J Am Soc Nephrol CJASN. January 6, 2018; 13(1):16-25.
35. Piano S, Gambino C, Vettore E, Calvino V, Tonon M, Boccagni P, et al. Response to Terlipressin and Albumin Is Associated With Improved Liver Transplant Outcomes in Patients With Hepatorenal Syndrome. Hepatol Baltim, Md., May 2021; 73(5):1909-19.
36. Analysis of Survival Benefits of Living Versus Deceased Donor Liver Transplant in High Model for End‐Stage Liver Disease and Hepatorenal Syndrome - Wong - 2021 - Hepatology - Wiley Online Library. Available in: https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/hep.31584
37. Lavayssière L, Kallab S, Cardeau-Desangles I, Nogier MB, Cointault O, Barange K, et al. Impact of molecular adsorbent recirculating system on renal recovery in type-1 hepatorenal syndrome patients with chronic liver failure. J Gastroenterol Hepatol. June 2013; 28(6):1019-24.
38. Bañares R, Nevens F, Larsen FS, Jalan R, Albillos A, Dollinger M, et al. Extracorporeal albumin dialysis with the molecular adsorbent recirculating system in acute-on-chronic liver failure: the RELIEF trial. Hepatol Baltim, Md., March 2013; 57(3):1153-62.
39. Torre A, Martín-Llahí M, Ginès P. Dilutional hyponatremia, refractory ascites and hepatorenal syndrome: current treatment. Gastroenterol Hepatol. 2004 Oct;27:26-39.
40. Kaptein EM, Oo Z, Kaptein MJ. Hepatorenal syndrome misdiagnosis may be reduced using inferior vena cava ultrasound to assess intravascular volume and guide management. Ren Fail. December 31, 2023; 45(1):2185468.
41. Wang L, Long Y, Li KX, Xu GS. Pharmacological treatment of hepatorenal syndrome: a network meta-analysis. Gastroenterol Rep. April 1, 2020; 8(2):111-8.
42. Velez JCQ, Karakala N, Tayebi K, Wickman TJ, Mohamed MMB, Kovacic RA, et al. Responsiveness to Vasoconstrictor Therapy in Hepatorenal Syndrome Type 1. Kidney360. April 2023; 4(4):E448.
43. Tseng HY, Lin YH, Lin CC, Chen CL, Yong CC, Lin LM, et al. Long-term renal outcomes comparison between patients with chronic kidney disease and hepatorenal syndrome after living donor liver transplantation. Front Surg. 2023;10. Available in: https://www.frontiersin.org/articles/10.3389/fsurg.2023.1116728
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Nov 10, 2023
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How to Cite
Katherine Lucía Gordón Reyes, & Manuel Rafael Aldás Erazo. (2023). HEPATORENAL SYNDROME: UPDATE. Journal of Population Therapeutics and Clinical Pharmacology, 30(18), 1909–1921. https://doi.org/10.53555/jptcp.v30i18.3377
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Author Biographies
Katherine Lucía Gordón Reyes
Estudiante de la carrera de Medicina de la Universidad Católica de Cuenca
Manuel Rafael Aldás Erazo
Docente Universidad Católica de Cuenca