Innovations in the concept and treatment of hepatorenal syndrome

Neringa Toliušytė1, Liveta Šniurevičiūtė1

1Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine, Kaunas, Lithuania


It is a very important factor to understand the definition in the treatment of hepatorenal syndrome (HRS). According to the new definition of HRS-1, it is renamed to HRS-acute kidney injury (AKI). In the definition of HRS-AKI, the final serum creatinine value is less important, because the aim is to encourage physicians to treat patients more quickly, even if the increase in serum creatinine is negligible. HRS-non-acute kidney injury (NAKI) (previously was HRS-2) is classified as HRS-chronic kidney disease (CKD) as renal structure and function impairment, which persists for more than 90 days in HRS-NAKI, as changes in renal structure and function, which do not meet the AKI criteria and last less than 90 days. Terlipressin alone for HRS treatment may result in decreased heart function and ischaemia. In contrast to terlipressin, albumin is able to maintain or enhance heart function even in the most advanced stages of cirrhosis. Various studies have shown that concomitant use of terlipressin with albumin results in significant improvements in renal function in patients with HRS-AKI.

Aim: To select and examine the latest publications on the definition and treatment of HRS.

Methods: The literature review was based on PubMed’s scientific database for the selection of publications on the concept and treatment of HRS.

Conclusions: Liver transplantation is the best treatment for HRS. Pending liver transplantation, vasoconstrictors with albumin are the most effective treatment, but due to the changed definitions of HRS-AKI and HRS-NAKI, such treatment is only effective for HRS-AKI and ineffective for HRS-NAKI.

Keywords: hepatorenal syndrome, concept, definition, treatment.