Hepatorenal syndrome of the 1-st and the 2-nd type: state-of-the-art
Abstract
The aim of review. To present modern concept on pathogenesis, up-to-date diagnostic criteria and approaches to treatment of hepatorenal syndrome (HRS).
Original positions of the review. At the last years in pathogenesis HRS, the role of cardiac and adrenal incompetence is discussed along with «classical hypothesis of peripheral vasodilation». It is shown, that in patients with HRS no adequate enhancement of renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system (SNS) activity is observed, that is related to development of specific cardiomyopathy at liver cirrhosis (LC). In development of adrenal failure at HRS addition of severe bacterial infection, activation of inflammatory mediators and activation of endogenous vasoconstrictors effects play a role. In 2005 in San Francisco new HRS diagnostic criteria for LC patients were proposed, that essentially reduces rate of false-positive HRS diagnostics. In relation to clinical severity and prognosis two HRS forms are defined. Application of vasoconstrictors (terlipressin) in combination to albumin considerably reduces severity of HRS of the 1-st type and allows to carry out liver transplantation (LT) which is a method of choice for these patients.
Conclusion. HRS is dreadful complication of acute and chronic liver diseases. In development of circulatory dysfunction at HRS, besides peripheral vasodilation, cardiac and adrenal failure play a major role. New diagnostic HRS criteria for LC patients are defined. Application of terlipressin and albumin increases survival rate of HRS patients and allows to carry out LT.
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Review
For citations:
Mammayev S.N., Karimova A.M. Hepatorenal syndrome of the 1-st and the 2-nd type: state-of-the-art. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2008;18(6):4-13. (In Russ.)
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