THE CONCEPT OF HEPATORENAL SYNDROME

Abstract

Hepatorenal syndrome is a life-threatening complication of liver cirrhosis. 90% of patients with liver cirrhosis die within 2 months of onset hepatorenal syndrome. For many years it was accepted as the only true guide the hypothesis of the hemodynamic mechanism of the occurrence of hepatorenal syndrome, according to which compensatory systemic vasodilation in response to portal hypertension causes renal ischemia and the development of a functional special physical acute kidney injury, the so-called "hepatorenal syndroma, acute kidney injury. There are two types of HRS. Type 1 HRS is characterized by a rapidly progressive impairment of the circulatory and renal functions associated with a very poor prognosis (median survival rate lower than 2 weeks). Type 2 HRS is characterized by a steady impairment of the circulatory and renal functions with a median survival of 6 months.The mechanism of development of HRS is based on a decrease in renal glomerular blood flow and, accordingly, glomerular filtration rate due to vasoconstriction of the renal vessels during vasodilation of the vessels of the abdominal organs, which leads to azotemia and an increase in serum creatinine. HRS develops a multiple organ pathology characterized by an acute dysfunction of vital organs and systems (liver, kidneys, brain, cardiovascular system). In general, the prognosis of HRS largely depends on the course of the hepatic process. Complete regression of HRS is observed with spontaneous liver function recovery or donor liver transplantation, and survival after liver transplantation in patients with prior HRS is worse than without it.