Advances in Hepatorenal Syndrome Pathophysiology, Diagnosis, and Treatment Approaches

Abstract

Recent advances in the understanding, diagnosis, and management of hepatorenal syndrome with acute kidney injury (HRS-AKI), a life-threatening complication of liver disease with high mortality are reviewed in this article. While this has led to a better understanding of the pathophysiology, including aspects of circulatory dysfunction, inflammation, and renal vasoconstriction itself, there is still no simple solution with an urgent need for timeliness diagnosis and treatment. At present, these remain quite limited, with the continued reliance on exclusionary methods of diagnosis and a lack of validated biomarkers. Background: A literature-based review outlines promising new diagnostic tools with potential to advance early diagnosis and prognosis including plasma cystatin C and urinary neutrophil gelatinase-associated lipocalin. Terlipressin, which was recently approved in the United States, is valued for its robust information on renal function improvement; however, safety concerns must be interpreted cautiously. Promising, but not well validated in clinical trials, other therapeutic options include transjugular intrahepatic portosystemic shunt and artificial liver support systems. It is concluded that liver transplantation remains the most definitive therapeutic option, but early identification of candidates and intervention remain key. These findings highlight the need for novel biomarkers and personalized treatment strategies to improve patient outcomes. The present review highlights the existing gaps that require more research in diagnostic and therapeutic strategies with a potential need for universal protocols to manage HRS-AKI.