Treatment of hepatorenal syndrome

• Absence of parenchymal kidney disease as indicated by proteinuria >500 mg/day, micro-hematuria (>50 RBC/high power field) and/or abnormal renal ultrasound International Ascites Club, November 2005 • No current or recent treatment with nephrotoxic drugs • Absence of shock b.w per day up to a maximum of 100 g/day • Serum creatinine over 1.5 mg/dL (133 μmol/L) • Cirrhosis with ascites Table 1: Diagnostic criteria for hepatorenal syndrome Table 1 lists the updated diagnostic criteria for HRS. The important changes from the previous diagnostic criteria of 10 years ago2 include the With the improved knowledge of the pathogenesis, HRS is now defined as a potentially reversible syn­ drome that occurs in patients with cirrhosis, ascites and liver failure. It is characterized by impaired renal function and marked abnormalities in cardiovascular function and activity of endogenous vasoactive sys­ tems. In the kidney, there is marked renal vasocon­ striction that results in low glomerular filtration rate. In the extra-renal circulation there is arterial vasodi­ latation that is located in the splanchnic circulation. A similar syndrome may also occur in acute liver failure. event (Fig 1). S ec on d h i t