Dear Editor,

Hepatorenal syndrome (HRS) is defined as the appearance of a renal injury in patients with chronic liver disease. It is of a functional origin and caused by systemic circulatory dysfunction, which leads to renal vasoconstriction secondary to the effect of increased vasoactive substances intended to compensate for initial splanchnic vasodilation [1]. HRS always develops in the context of circulatory dysfunction, mainly in the splanchnic arterial territory, and is generally associated with ascites and hyponatremia due to the activation of neurohormonal systems [2].

The diagnosis of this pathology is clinical and its definition and classification have been updated according to the criteria for acute kidney injury (AKI) [3]. The HRS diagnostic criteria proposed by ICA-AKI are:

(1) Previous diagnosis of chronic liver disease and ascites; (2) AKI diagnosis; (3) No response after 2 consecutive days of diuretic withdrawal and plasma volume expansion with albumin (1 g/kg body weight); (4) Absence of shock; (5) Current or recent use of nephrotoxic drugs (nonsteroidal anti-inflammatory drugs, aminoglycosides, iodinated contrast media, etc.); and (6) No macroscopic evidence of structural kidney injury, defined as no proteinuria (>500 mg/day), no microhaematuria (>50 red blood cells per high-power field), and normal renal ultrasound findings [2-3].

In terms of treatment, the use of albumin is indicated for the prevention of circulatory dysfunction that occurs in the acute context of the disease based on its beneficial effect as a plasma expander; however, more recent studies also indicate that albumin decreases the systemic inflammatory response and reduces proinflammatory substances [4]. In addition, it can improve autoregulation of renal perfusion, which can lead to a reduction in oxidative stress and endothelial activation [5].

Different methods of prevention and reduction of mortality have been studied, such as the placement of a transjugular intrahepatic portosystemic shunt (TIPS) [4]. This technique has been used successfully in individuals with recurrent ascites with excellent results in terms of morbidity and mortality [5]. However, further trials are needed to consolidate its efficacy in the treatment of hepatorenal dysfunction and its benefit-risk assessment [6-8].

Conflict of Interest

We declare that we have no conflict of interest related to the content of this article.

Funding

We declare that we have not received any funding to write this article.

Acknowledgments

None.

References

1. Heimbach JK, Kulik LM, Finn RS, Sirlin CB, Abecassis MM, et al. (2018) AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology 67: 358-380. [Ref.]
2. Simbrunner B, Trauner M, Reiberger T, Mandorfer M (2021) Recent advances in the understanding and management of hepatorenal syndrome. Faculty Reviews 10. [Ref.]
3. Marrero JA, Kulik LM, Sirlin CB, Zhu AX, Finn RS, et al. (2018) Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 68: 723-750. [Ref.]
4. Gullello R, Alejandro E (2015) Insuficiencia renal en la cirrosis: Evaluación de nuevas clasificaciones pronósticas y tratamiento del síndrome hepatorenal tipo 1 asociado a sepsis. Universitat de Barcelona. [Ref.]
5. Salerno F, Navickis RJ, Wilkes MM (2013) Albumin infusion improves outcomes of patients with spontaneous bacterial peritonitis: a meta-analysis of randomized trials. Clin Gastroenterol Hepatol 11: 123-130. [Ref.]
6. Plauth M, Bernal W, Dasarathy S, Merli M, Plank LD, et al. (2020) ESPEN Guideline on Clinical Nutrition in Liver Disease. Clin Nutr 39: 485-521. [Ref.]
7. Belcher JM, Sanyal AJ, Peixoto AJ, Perazella MA, Lim J, et al. (2014) Kidney biomarkers and differential diagnosis of patients with cirrhosis and acute kidney injury. Hepatology 60: 622-632. [Ref.]
8. Caraceni P, Riggio O, Angeli P, Alessandria C, Neri S, et al. (2018) Long-term albumin administration in decompensated cirrhosis (ANSWER): an open-label randomised trial. Lancet 391: 2417-2429. [Ref.]

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Article Information

Article Type: LETTER TO EDITOR

Citation: Abuabara-Franco E, Sáenz-López J, Restom-Arrieta J, Bohórquez-Rivero J, Licona-Vera C, et al. (2022) Prevention of Hepatorenal Syndrome, As a Complication of Liver Cirrhosis. Int J Nephrol Kidney Fail 8(2): dx.doi.org/10.16966/2380-5498.227

Copyright: © 2022 Abuabara-Franco E, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication history: 

Received date: 22 Jul, 2022

Accepted date: 04 Aug, 2022

Published date: 15 Aug, 2022