ETIOLOGY, DIAGNOSIS AND TREATMENT OF HEPATORENAL SYNDROME

Abstract

Hepatorenal syndrome (HRS) is a serious complication associated with advanced liver cirrhosis, characterized by progressive renal dysfunction in patients with liver dysfunction. The etiology of HRS is linked to complex hemodynamic changes, including splanchnic vasodilation and activation of the sympathetic nervous system, leading to reduced renal blood flow and renal dysfunction. Its diagnosis is challenging due to overlapping symptoms with other complications of cirrhosis. Treatment seeks to improve renal blood flow and address underlying liver dysfunction, with liver transplantation being the definitive intervention. Objective: The objective of this systematic review is to analyze recent studies on the etiology, diagnosis and treatment of hepatorenal syndrome in order to provide a comprehensive understanding of advances in the field and identify gaps in the literature. Methodology: The review was carried out in accordance with PRISMA guidelines. Articles published in the last 10 years were selected from the PubMed, Scielo and Web of Science databases, using the descriptors "hepatorenal syndrome", "etiology", "diagnosis", "treatment" and "liver cirrhosis". The inclusion criteria were original human studies, published in English or Portuguese, focusing on HRS. Exclusion criteria included animal studies, systematic reviews, and studies with small sample sizes. Results: The studies reviewed highlighted the importance of splanchnic vasodilation and activation of the sympathetic nervous system in the etiology of HRS. The diagnosis was based on the criteria established by the International Ascites Club, with emphasis on excluding other causes of renal failure. Regarding treatment, therapy with albumin and vasoconstrictors proved to be effective in improving renal function, while liver transplantation remained the only curative option. Conclusion: Hepatorenal syndrome is a serious complication of advanced liver cirrhosis, requiring a multidisciplinary approach for its management. Recent advances in understanding its etiology and therapeutic strategies highlight the importance of early identification and appropriate treatment to improve the clinical outcomes of these patients. However, more research is needed to fully elucidate its pathophysiology and develop more effective therapies.