Hepatorenal syndrome in cirrhosis: pathogenesis and treatment.

Hepatorenal syndrome (HRS) is a major complication in cirrhosis, with an annual incidence in patients with ascites of approximately 8%.1 It develops at the latest phase of the disease and, although initially considered without impact in prognosis (patients would die with and not by the renal failure), there is now evidence that it is an important determinant in survival. There are more reviews than original articles on HRS, reflecting the difficulty in investigating this syndrome. On the other hand, there is no experimental model of HRS. Many aspects of HRS are therefore still poorly understood. The current article does not attempt a deep review of HRS. The reader is referred to other reviews for this purpose.2–10 Diagnosis of HRS, which has been discussed in detail elsewhere,2 is superficially considered. The treatment of refractory ascites, a common event in patients with HRS, is not reviewed. The aim of this work is to highlight those aspects of HRS that are important to understand the pathogenesis and the rational basis of the modern therapy of the syndrome.