THE HEPATORENAL-SYNDROME

Hepatorenal syndrome may occur in any form of severe liver disease. It appears less common in children than adults, but still carries a poor prognosis. There are several factors involved in its aetiology, inclu ding a decreased renal perfusion pressure, activation of the renal sym pathetic nervous system and increased synthesis of several vasoactive mediators, which may modulate glomerular filtration by acting as both renal vasoconstrictors and dynamic regulators of the glomerular capill ary ultrafiltration coefficient, through their action on mesangial cel ls. This review will discuss the pathophysiology of the hepatorenal sy ndrome and some of the principles of management of patients with renal failure and severe liver disease. The role of renal support and liver transplantation will also be covered.