Review article: pharmacological treatment of the hepatorenal syndrome in cirrhotic patients

Renal failure is common in patients who are dying from end-stage cirrhosis, developing in 40-80% of all patients. Where there is no anatomical or path ological cause for the renal failure, it is termed the hepatorenal syndrome . When the hepatorenal syndrome develops, it will only recover when there i s some degree of improvement in liver function. Thus for most patients this will occur only after liver transplantation, although the transplantation mortality is increased in this group. Hepatorenal syndrome is a common comp lication of alcoholic hepatitis, and this group is unusual in that with tim e and abstinence, significant recovery of liver function may occur. There i s therefore a need for supportive therapy to allow time for some recovery o f liver function in patients with alcoholic hepatitis and hepatorenal syndr ome. Similarly, patients may need support whilst waiting for liver transpla ntation. This article reviews the pathophysiology and treatment of hepatore nal syndrome.