Hepatorenal Syndrome.

The management of the hepatorenal syndrome (HRS) constitutes a major challenge for clinicians. Because HRS is a functional disorder due to advanced liver disease and is associated with a very low survival expectancy, orthotopic liver transplantation (OLT) is the only effective and permanent treatment for patients with HRS. However, OLT is not applicable to all cirrhotic patients despite the presence of HRS. In addition, because of the poor prognosis of HRS and the prolonged waiting lists in most transplant centers a significant proportion of these patients may die before OLT is possible. Therefore, there is a need for effective therapies for HRS that improve renal function and increase survival. Such treatments are of interest not only as a bridge to OLT but also as a therapy for patients who are not candidates for transplantation. Preliminary studies have suggested that the administration of splanchnic vasoconstrictors such as terlipressin in combination with volume expanders or the insertion of transjugular intrahepatic portosystemic shunts (TIPS) may improve renal function in patients with HRS. However, before these treatments are widely recommended further studies are necessary.