Hepatorenal syndrome: current diagnostic and therapeutic concepts

Of the various complications in liver cirrhosis includ- ing intestinal bleeding, ascites and hepatocellular carcinoma, the rapidly progressive form of kidney dysfunction in cirrhosis, i.e. hepatorenal syndrome type 1, still carries the worst prognosis. In the early 1990s, median survival of these patients was reported to be as short as two weeks (1) and some more recent papers indicate that, in terms of prognosis, there has not been much progress since (2). However, during the past two decades, new treatment concepts based on an improved pathophysiological understanding of the mechanisms ultimately leading to hepatorenal syn- drome (HRS) have been introduced, and—very recently—a first randomized, controlled trial evaluat- ing one of these concepts (i.e. vasoconstrictor treat- ment with the vasopressin analogue terlipressin) has been published in abstract form (3). Despite successful drug treatment approaches, to date, the only definitive treatment of HRS type 1 is liver transplantation or even combined liver/kidney transplantation in some patients. This article aims at reviewing the currently available data on diagnosis, prognosis and treatment of hepatorenal syndrome.