Author information

¹Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.

²Section of Gastroenterology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston TX, USA.

³Toronto Centre for Liver Disease, University Health Network, Toronto, Canada.

⁴Division of Gastroenterology, Department of Medicine, University of California-San Francisco, San Francisco CA, USA.

Abstract

Hepatorenal syndrome (HRS) is a rare and highly morbid form of kidney injury unique to patients with decompensated cirrhosis. HRS is a physiologic consequence of portal hypertension, leading to a functional kidney injury that can be reversed by restoring effective circulating volume and renal perfusion. While liver transplantation (LT) is the only definitive "cure" for HRS, medical management with vasoconstrictors and intravenous albumin are a cornerstone of supportive care. Terlipressin, a V1a receptor agonist that acts on the splanchnic circulation, has been used for many years outside the United States for the treatment of HRS. However, its recent Food and Drug Administration (FDA) approval has generated new interest in this population, as a new base of prescribers now work to incorporate the drug into clinical practice. In this article, we review HRS pathophysiology and diagnostic criteria, clinical use of terlipressin and alternative therapies, and identify areas of future research in the space of HRS and kidney injury in cirrhosis.