Overview of Hepatorenal Syndrome

Öz

Hepatorenal syndrome (HRS) is a severe complication of advanced cirrhosis associated with high mortality. Since no specific diagnostic test exists, the diagnosis is primarily based on exclusion. It should be particularly considered in cirrhotic patients who develop new-onset renal dysfunction. The pathophysiology of HRS is highly complex; cirrhosis-related hemodynamic alterations, vascular dysregulation, and impairment of antioxidant defense mechanisms contribute to its development. Therapeutic approaches are likewise multifaceted. The initial step involves the correction of precipitating factors. Albumin administration and vasoconstrictor therapy represent the cornerstone of current management strategies. However, once HRS develops, it is often difficult to treat and is associated with poor outcomes. Therefore, recognizing risk factors, identifying preventable causes at an early stage, and promptly implementing appropriate supportive measures are of critical importance. Current evidence indicates that many aspects of HRS pathophysiology and treatment remain unclear. Given its high mortality rate and therapeutic challenges, improved understanding and management of this syndrome by clinicians are essential for optimizing patient care. This review also highlights practical diagnostic challenges and emerging biomarker-based approaches, emphasizing future directions for improved management of HRS-AKI.

Anahtar Kelimeler

• Hepatorenal Syndrome
• Cirrhosis
• Acute Kidney Injury
• Liver
• Kidney

Hepatorenal Sendroma Genel Bakış

Öz

Hepatorenal sendrom (HRS), ileri evre sirozda görülen ve yüksek mortalite ile seyreden ciddi bir komplikasyondur. Spesifik bir tanı yöntemi bulunmadığından, tanı, çoğunlukla dışlama esasına dayanır. Özellikle yeni gelişen böbrek fonksiyon bozukluğu olan siroz hastalarında klinik olarak akılda bulundurulması gereken bir durumdur. HRS’nin patofizyolojisi oldukça karmaşıktır; siroza bağlı hemodinamik değişiklikler, vasküler disregülasyon ve antioksidan savunma mekanizmalarındaki bozulmalar bu sürece katkıda bulunmaktadır. Tedavi yaklaşımları da benzer şekilde çok boyutludur. Öncelikli olarak kolaylaştırıcı faktörlerin ortadan kaldırılması esastır. Albümin replasmanı ve vazokonstriktör ajanların kullanımı güncel tedavi stratejilerinin temelini oluşturmaktadır. Ancak sendrom geliştiğinde, yönetimi zor ve sıklıkla yetersiz kalan bir klinik tablo ile karşılaşılmaktadır. Bu nedenle, risk faktörlerinin iyi anlaşılması, önlenebilir nedenlerin erken dönemde tanımlanarak ortadan kaldırılması ve uygun destek tedavilerinin zamanında uygulanması büyük önem taşımaktadır. Mevcut bilgiler HRS’nin patofizyolojisi ve tedavisinde birçok bilinmeyen olduğunu göstermektedir. Yüksek mortalite oranı ve tedavi güçlükleri göz önünde bulundurulduğunda, bu sendromun klinisyenler tarafından daha iyi anlaşılması ve yönetilmesi klinik pratik açısından kritik öneme sahiptir. Bu derleme ayrıca HRS-AKI’nin tanısındaki pratik zorluklara ve biyobelirteç temelli yeni yaklaşımlara dikkat çekmekte, gelecekteki yönetim stratejilerinin geliştirilmesine yönelik olası yönelimleri vurgulamaktadır.

Anahtar Kelimeler

• Hepatorenal Sendrom
• Siroz
• Akut Böbrek Hasarı
• Karaciğer
• Böbrek

Kaynakça

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