Advances in the treatment of hepatorenal syndrome

Hepatorenal syndrome is one of the major complications of decompensated cirrhosis secondary to the reduction in effective blood volume,imbalance of endogenous vasoactive substances,and the reduction in renal blood flow,with renal insufficiency as the main manifestation. In clinical practice,hepatorenal syndrome mainly manifests as the reduction in renal blood flow and glomerular filtration rate,with no marked changes in renal histology. The treatment of hepatorenal syndrome should start as soon as it is diagnosed. Current therapeutic modalities include the following:( 1) general supportive therapies for primary diseases and predisposing factors;( 2) pharmacotherapy,including albumin and vasoactive agents;( 3) renal replacement therapy;( 4) molecular adsorbent recirculating system;( 5) transjugular intrahepatic portosystemic shunt;( 6) liver transplantation. Liver transplantation is the optimal regimen for the treatment of hepatorenal syndrome,and the other methods including pharmacotherapy and renal replacement therapy are often used as transitional therapies before liver transplantation. Albumin combined with terlipressin is currently the preferred regimen of pharmacotherapy for hepatorenal syndrome. This article reviews the new concepts and advances in the treatment of hepatorenal syndrome.