Circulatory disturbance and renal dysfunction in liver disease and in obstructive jaundice.

The appearance of hepatorenal syndrome in a patient with acute or chronic liver disease is associated with a dismal outcome. Thus, management of HRS remains a formidable challenge to the aggressiveness and perseverance of the physician. The best treatment for HRS remains prevention based on avoidance of circulating volume contraction or the use of nephrotoxic drugs. Treatment for established HRS remains a frustrating experience with recovery being rare. A successful liver transplantation is currently the only definitive treatment that can reverse HRS. As this procedure is being performed with increasing frequency and encouraging results, a new window of hope has been opened for these patients.