Minerva Gastroenterology 2021 Apr 08

DOI: 10.23736/S2724-5985.21.02816-6

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Renal dysfunctions and liver disease: a brief update on management with particular attention to hepatorenal syndrome

Monica SURACE ¹ ✉, Immacolata ANDRIA ², Giovanni VALENTINI ¹

¹ Gastroenterology Unit, Rivoli Hospital, Rivoli, Turin, Italy; ² Emergency Department, Maria Vittoria Hospital, Turin, Italy

In 2015 the International Club of Ascites gave an accurate, exact and new definition of acute renal injury in cirrhotic patient, identifying objective criteria of severity and recoding Hepatorenal Syndrome as a particular form of renal dysfunction for which excessive renal vasoconstriction is one of the main, but not the only, pathophysiological mechanisms. In this review we have tried to outline new pathophysiological and therapeutic insights and to summarize the most recent recommendations. Vasopressor such as terlipressin and norepinephrine, in combination with albumin, still represent the first line therapy, but the new discoveries in the pathophysiology of the disease have led the search for to new pharmacological approaches, although, to date, the only definitive remedy is represented by liver (or simultaneous liver-kidney) transplantation.

KEY WORDS: Cirrhosis; Hepatorenal syndrome; Vasoconstrictors; Liver transplantaion