Hepatorenal syndrome (HRS), a progressive but potentially reversible deterioration of kidney function, remains a major complication in patients with advanced cirrhosis, often leading to death before liver transplantation (LT). Recent updates in the pathophysiology, definition, and classification of HRS have led to a complete revision of the nomenclature and diagnostic criteria for HRS type 1, which was renamed HRS-acute kidney injury (AKI). HRS is characterized by severe impairment of kidney function due to increased splanchnic blood flow, activation of several vasoconstriction factors, severe vasoconstriction of the renal arteries in the absence of kidney histologic abnormalities, nitric oxide dysfunction, and systemic inflammation. Diagnosis of HRS remains a challenge because of the lack of specific diagnostic biomarkers that accurately distinguishes structural from functional AKI, and mainly involves the differential diagnosis from other forms of AKI, particularly acute tubular necrosis. The optimal treatment of HRS is LT. While awaiting LT, treatment options include vasoconstrictor drugs to counteract splanchnic arterial vasodilation and plasma volume expansion by intravenous albumin infusion. In patients with HRS unresponsive to pharmacological treatment and with conventional indications for kidney replacement therapy (KRT), such as volume overload, uremia, or electrolyte imbalances, KRT may be applied as a bridging therapy to transplantation. Other interventions, such as transjugular intrahepatic portosystemic shunt, and artificial liver support systems have a very limited role in improving outcomes in HRS. Although recently developed novel therapies have potential to improve outcomes of patients with HRS, further studies are warranted to validate the efficacy of these novel agents.
Citations
Citations to this article as recorded by
Paracentesis exceeding three liters increases risks of acute kidney injury even in cirrhotic patients with albumin infused refractory ascites Pei-Shan Wu, Kuei-Chuan Lee, Chih-Yu Li, Yun-Cheng Hsieh, Teh-Ia Huo, Han-Chieh Lin, Ming-Chih Hou Journal of the Formosan Medical Association.2026; 125(3): 268. CrossRef
Outcomes of Highly Urgent ABO-Incompatible Living Donor Liver Transplantation in National Databases Jongman Kim, Sang Jin Kim, Boram Park, Kyunga Kim, YoungRok Choi, Geun Hong, Jun Yong Park, Young Seok Han, Nam-Joon Yi, Seung Heui Hong, Soon-Young Kim, Jungbun Park, Youngwon Hwang, Dong-Hwan Jung Journal of Korean Medical Science.2026;[Epub] CrossRef
Rising mortality due to coexisting liver cirrhosis and kidney failure in the United States (1999–2023): A nationwide retrospective analysis Muhammad Shaheer Bin Faheem, Syed Tawassul Hassan, Syeda Umbreen Munir, Muhammad Idrees Khan Medicine.2026; 105(9): e47662. CrossRef
Neurofilament light chain proteins are a sensitive biomarker of neuronal damage in cirrhotic patients with hepatic encephalopathy Clelia Asero, Francesca Polito, Maria Stella Franzé, Antonio Battaglia, Claudia Ligresti, Teresa Maltese, Irene Cacciola, M’Hammed Aguennouz, Vincenzo Macaione Frontiers in Molecular Biosciences.2026;[Epub] CrossRef
Trends and Demographics of Hepatorenal Syndrome-Related Mortality in the U.S., 1999–2024: A CDC WONDER Analysis Syed Faisal Ali, Julia Natche, Mahendrakumar Achlaram Chaudhari, Hassan Abbasi, Sammy Dawoud, Hany Dawoud, Amna Shoaib, Hersh Tilokani, Harleen Kaur Chela, Arsal Zafar Diseases.2026; 14(3): 106. CrossRef
Fungal ribosomally synthesized and post-translationally modified peptides (F-RiPPs): Biosynthesis, genome mining, structural diversity, and translational potential as targeted anticancer ADC payloads S.T. Gopukumar, Madhumita Saha, Purbasha Das, Punniyamoorthy Sheela, M Komala, Jayaramareddy Harish, Karpakavalli Meenakshi Sundaram, Samer Shamshad, Uddalak Das Fitoterapia.2026; 192: 107283. CrossRef
Association of visceral fat obesity with structural change in abdominal organs: fully automated three-dimensional volumetric computed tomography measurement using deep learning Haruka Kiyoyama, Masahiro Tanabe, Mayumi Higashi, Naohiko Kamamura, Yosuke Kawano, Kenichiro Ihara, Keiko Hideura, Katsuyoshi Ito Abdominal Radiology.2025; 50(9): 4395. CrossRef
Understanding and Treating Hepatorenal Syndrome: Insights from Recent Research Yuli Song, Xiaochen Yang, Chengbo Yu Seminars in Liver Disease.2025; 45(03): 328. CrossRef
Ascites complications risk factors of decompensated cirrhosis patients: logistic regression and prediction model Xiaolong Zheng, Wei Wei BMC Gastroenterology.2025;[Epub] CrossRef
Emergency living donor liver transplantation Jongman Kim Annals of Liver Transplantation.2025; 5(1): 27. CrossRef
Assessment of Albumin Therapy and Paracentesis Interval in Cirrhotic Patients With Recurrent Ascites: A Prospective Cohort Study Muhammad Abdullah Khan, Hafiz Muhammad Faizan Mughal, Shehwar Ahmed, M Khaliq, Abdul Ghafoor Cureus.2025;[Epub] CrossRef
Acute Kidney Injury in Patients with Liver Cirrhosis: From Past to Present Definition and Diagnosis Andreea Lungu, Georgiana-Elena Sarbu, Alexandru Sebastian Cotlet, Ilie-Andreas Savin, Ioana-Roxana Damian, Simona Juncu, Cristina Muzica, Irina Girleanu, Ana-Maria Sîngeap, Carol Stanciu, Anca Trifan, Camelia Cojocariu Life.2025; 15(8): 1249. CrossRef
Oral Branched-Chain Amino Acids as a Cost-Effective Option for Managing Hepatic Encephalopathy Hankil Lee, Sang Hoon Ahn, Beom Kyung Kim Yonsei Medical Journal.2025; 66(11): 713. CrossRef
Life after hepatorenal syndrome: unraveling quality of life, psychological distress, and treatment preferences J. Müller-Kühnle, M. Schanz, J. Latus, D. Marschner, S. Schricker BMC Palliative Care.2025;[Epub] CrossRef
The Kidney in the Shadow of Cirrhosis: A Critical Review of Renal Failure Livia-Mirela Popa, Paula Anderco, Oana Stoia, Cristian Ichim, Corina Porr Biomedicines.2025; 13(11): 2775. CrossRef
Predicting risk factors for waiting mortality in adult emergent living donor liver transplantation based on Korean national data Sang Jin Kim, Jongman Kim, Kyunga Kim, Soon-Young Kim, Jung-Bun Park, Youngwon Hwang, Dong-Hwan Jung Annals of Liver Transplantation.2025; 5(2): 107. CrossRef
VWF/ADAMTS13 Ratio as a Potential Predictive Biomarker for Acute Kidney Injury Onset in Cirrhosis Shohei Asada, Tadashi Namisaki, Kosuke Kaji, Hiroaki Takaya, Takahiro Kubo, Takemi Akahane, Hideto Kawaratani, Norihisa Nishimura, Soichi Takeda, Hiroyuki Masuda, Akihiko Shibamoto, Takashi Inoue, Satoshi Iwai, Fumimasa Tomooka, Yuki Tsuji, Yukihisa Fujin Digestive Diseases and Sciences.2024; 69(3): 851. CrossRef
Gut Microbiota and Biomarkers of Endothelial Dysfunction in Cirrhosis Irina Efremova, Roman Maslennikov, Elena Poluektova, Oleg Medvedev, Anna Kudryavtseva, George Krasnov, Maria Fedorova, Filipp Romanikhin, Vyacheslav Bakhitov, Salekh Aliev, Natalia Sedova, Tatiana Kuropatkina, Anastasia Ivanova, Maria Zharkova, Ekaterina International Journal of Molecular Sciences.2024; 25(4): 1988. CrossRef
Infection-Related Readmissions Are Rising among Patients with Hepatorenal Syndrome: A Nationwide Analysis Umer Farooq, Zahid I. Tarar, Ammad J. Chaudhary, Abdallah E. Alayli, Faisal Kamal, Chengdu Niu, Kamran Qureshi Livers.2024; 4(2): 268. CrossRef
Management of hepatorenal syndrome and treatment-related adverse events Lorenzo Peluso, Marzia Savi, Giacomo Coppalini, Deliana Veliaj, Nicola Villari, Giovanni Albano, Stephen Petrou, Maria C. Pace, Marco Fiore Current Medical Research and Opinion.2024; 40(7): 1155. CrossRef
Features of the course of hepatorenal syndrome in decompensated portal hypertension (case report) M.I. Tutchenko, D.V. Rudyk, M.S. Besedinskyi, S.L. Chub, Yu.V. Nerushchenko GASTROENTEROLOGY.2024; 58(2): 151. CrossRef
Protective effect of long-chain polyunsaturated fatty acids on hepatorenal syndrome in rats João Bruno Beretta Duailibe, Cassiana Macagnan Viau, Jenifer Saffi, Sabrina Alves Fernandes, Marilene Porawski World Journal of Nephrology.2024;[Epub] CrossRef
Treatment-Related Cost Analysis of Terlipressin for Adults with Hepatorenal Syndrome with Rapid Reduction in Kidney Function Xingyue Huang, Jas Bindra, Ishveen Chopra, John Niewoehner, George J. Wan Advances in Therapy.2023; 40(12): 5432. CrossRef
First
Prev
