Guideline updates for definition, diagnosis and management of hepatorenal syndrome

DOI: https://doi.org/10.31450/ukrjnd.2(66).2020.09
Keywords: hepatorenal syndrome, acute kidney injury, stage, vasopressors, albumin, transplantation.

Abstract

Hepatorenal syndrome (HRS) is a unique form of acute kidney injury (AKI) developing in patients with end‐stage liver disease. AKI is a frequent complication in advanced cirrhosis patients which is associated with increased hospital admissions and decreased survival. The definition of AKI in cirrhosis has been recently modified and the new diagnostic criteria are based on small changes in serum creatinine with respect to previous values, occurring within a short period of time.

Systemic circulatory dysfunction and marked kidney vasoconstriction play a key role in the development of HRS. The modification of the AKI definition has also led to a change in the diagnostic criteria of HRS. The new diagnostic criteria are based on AKI stages and there is no need to reach a specific serum creatinine threshold. The use of the new HRS definition may lead to an earlier identification of renal impairment and better prognostic stratification. According to these new criteria, treatment with vasoconstrictors and albumin for the management of HRS will be started at lower serum creatinine values, with expected higher response rates. There are consistent data showing that some urine biomarkers, particularly NGAL (neutrophil gelatinase‐associated lipocalin), may be useful in daily clinical practice for the differential diagnosis of the cause of AKI in cirrhosis. Various HRS treatment regimens are available worldwide and all are designed to increase the mean arterial pressure by increasing the central blood volume and decreasing splanchnic vasodilation, and to serve as bridge to liver transplantation.

Downloads

Download data is not yet available.

References

Xiong J, Pu L, Xiong H, Xiang P, Zhang M, Liu J, Li A. Evaluation of the criteria of hepatorenal syndrome type of acute kidney injury in patients with cirrhosis admitted to ICU. Scand J Gastroenterol. 2018;53(12):1590-1596. doi: 10.1080/00365521.2018.1545423.

Ye X, Liu X, Song D, Zhang X, Zhu B, Wei L, Pei X, Wu J, Lou T, Zhao W. Estimating glomerular filtration rate by serum creatinine or/and cystatin C equations: An analysis of multi-centre Chinese subjects. Nephrology (Carlton). 2016;21(5):372-8. doi: 10.1111/nep.12636.

Solé C, Pose E, Solà E, Ginès P. Hepatorenal syndrome in the era of acute kidney injury. Liver Int. 2018;38(11):1891‐1901. doi:10.1111/liv.13893.

Angeli P, Gines P, Wong F, Bernardi M, Boyer TD, Gerbes A, Moreau R, Jalan R, Sarin SK, Piano S, et al; International Club of Ascites. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. Gut. 2015 Apr;64(4):531-7. doi: 10.1136/gutjnl-2014-308874. Epub 2015 Jan 28. PMID: 25631669.

Angeli P, Garcia-Tsao G, Nadim MK, Parikh CR. News in pathophysiology, definition and classification of hepatorenal syndrome: A step beyond the International Club of Ascites (ICA) consensus document. J Hepatol. 2019;71(4):811‐822. doi:10.1016/j.jhep.2019.07.002

Wong F. Acute kidney injury in liver cirrhosis: new definition and application. Clin Mol Hepatol. 2016;22(4):415-422. doi:10.3350/cmh.2016.0056.

Facciorusso A, Chandar AK, Murad MH, Prokop LJ, Muscatiello N, Kamath PS, Singh S. Comparative efficacy of pharmacological strategies for management of type 1 hepatorenal syndrome: a systematic review and network meta-analysis. Lancet Gastroenterol Hepatol. 2017 Feb;2(2):94-102. doi: 10.1016/S2468-1253(16)30157-1.

Russ KB, Stevens TM, Singal AK. Acute Kidney Injury in Patients with Cirrhosis. J Clin Transl Hepatol. 2015;3(3):195‐204. doi:10.14218/JCTH.2015.00015.

Alobaidi R, Basu RK, Goldstein SL, Bagshaw SM. Sepsis-associated acute kidney injury. Semin Nephrol. 2015;35(1):2‐11. doi:10.1016/j.semnephrol.2015.01.002.

Singh V, Ghosh S, Singh B, Kumar P, Sharma N, Bhalla A, Sharma AK, et al. Noradrenaline vs. terlipressin in the treatment of hepatorenal syndrome: a randomized study. J Hepatol. 2012 Jun;56(6):1293-8. doi: 10.1016/j.jhep.2012.01.012.

Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A; Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11(2):R31. doi: 10.1186/cc5713.

Stevens PE, Levin A; Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158(11):825‐830. doi:10.7326/0003-4819-158-11-201306040-00007

European Association for the Study of the Liver; European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis [published correction appears in J Hepatol. 2018;69(5):1207]. J Hepatol. 2018;69(2):406‐460. doi:10.1016/j.jhep.2018.03.024.

Cholongitas E, Ioannidou M, Goulis I, Chalevas P, Ntogramatzi F, Athanasiadou Z, et al. Comparison of creatinine and cystatin formulae with 51 Chromium-ethylenediaminetetraacetic acid glomerular filtration rate in patients with decompensated cirrhosis. J Gastroenterol Hepatol. 2017;32(1):191-198. doi: 10.1111/jgh.13446.

Glass L, Sharma P. Evidence-Based Therapeutic Options for Hepatorenal Syndrome. Gastroenterology. 2016;150(4):1031‐1033. doi:10.1053/j.gastro.2016.02.050.

Cavallin M, Kamath PS, Merli M, Fasolato S, Toniutto P, Salerno F, Bernardi M, Romanelli RG, Colletta C, et al; Italian Association for the Study of the Liver Study Group on Hepatorenal Syndrome. Terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of hepatorenal syndrome: A randomized trial. Hepatology. 2015;62(2):567-74. doi: 10.1002/hep.27709.

Srivastava S, Shalimar, Vishnubhatla S, Prakash S, Sharma H, Thakur B, Acharya SK. Randomized Controlled Trial Comparing the Efficacy of Terlipressin and Albumin with a Combination of Concurrent Dopamine, Furosemide, and Albumin in Hepatorenal Syndrome. J Clin Exp Hepatol. 2015;5(4):276-85. doi: 10.1016/j.jceh.2015.08.003.

Boyer TD, Sanyal AJ, Wong F, Frederick RT, Lake JR, O'Leary JG, Ganger D, Jamil K, Pappas SC; REVERSE Study Investigators. Terlipressin Plus Albumin Is More Effective Than Albumin Alone in Improving Renal Function in Patients With Cirrhosis and Hepatorenal Syndrome Type 1. Gastroenterology. 2016;150(7):1579-1589.e2. doi: 10.1053/j.gastro.2016.02.026.

Cavallin M, Piano S, Romano A, Fasolato S, Frigo AC, Benetti G, Gola E, Morando F, et al. Terlipressin given by continuous intravenous infusion versus intravenous boluses in the treatment of hepatorenal syndrome: A randomized controlled study. Hepatology. 2016;63(3):983-92. doi: 10.1002/hep.28396.

Gluud LL, Christensen K, Christensen E, Krag A. Terlipressin for hepatorenal syndrome. Cochrane Database Syst Rev. 2012;(9):CD005162. doi:10.1002/14651858.CD005162.pub3

Ortega R, Ginès P, Uriz J, Cárdenas A, Calahorra B, De Las Heras D, Guevara M, Bataller R, Jiménez W, Arroyo V, Rodés J. Terlipressin therapy with and without albumin for patients with hepatorenal syndrome: results of a prospective, nonrandomized study. Hepatology. 2002 Oct;36(4 Pt 1):941-8. doi: 10.1053/jhep.2002.35819.

Garcia-Martinez R, Caraceni P, Bernardi M, Gines P, Arroyo V, Jalan R. Albumin: pathophysiologic basis of its role in the treatment of cirrhosis and its complications. Hepatology. 2013;58(5):1836‐1846. doi:10.1002/hep.26338

Piano S, Schmidt HH, Ariza X, Amoros A, Romano A, Hüsing-Kabar A, Solà E, Gerbes A, Bernardi M, Alessandria C, et al; EASL CLIF Consortium, European Foundation for the Study of Chronic Liver Failure (EF Clif). Association Between Grade of Acute on Chronic Liver Failure and Response to Terlipressin and Albumin in Patients With Hepatorenal Syndrome. Clin Gastroenterol Hepatol. 2018;16(11):1792-1800.e3. doi: 10.1016/j.cgh.2018.01.035.

Rodriguez E, Henrique Pereira G, Solà E, Elia C, Barreto R, Pose E, et al. Treatment of type 2 hepatorenal syndrome in patients awaiting transplantation: Effects on kidney function and transplantation outcomes. Liver Transpl. 2015;21(11):1347-54. doi: 10.1002/lt.24210.


Abstract views: 708
PDF Downloads: 17750
Published
2020-03-20
How to Cite
Kolesnyk, M. (2020). Guideline updates for definition, diagnosis and management of hepatorenal syndrome. Ukrainian Journal of Nephrology and Dialysis, (2(66), 62-70. https://doi.org/10.31450/ukrjnd.2(66).2020.09
Issue
No 2(66) (2020): Ukrainian Journal of Nephrology and Dialysis
Section
Nephrology School