Update In Hepatorenal Syndrome

The hepatorenal syndrome is still a condition associated with poorprognosis. However, the knowledge of the patho-physiology behind this severe complication to cirrhosis has improved considerably. The future approach will probably be to attack different aspects in the patho- physiological process. A multi-target strategy should seek efficiently to counteract the arterial vasodilatation, central hypovolemia and arterial hypotension.There are a number of therapies that may be directed towards themanagement of renal failure in cirrhosis. Vasoconstrictor therapy with volume expansion remains the mainstay of treatment for the majority of patients with HRS.Recently, the molecular adsorbent recirculating system (MARS) hasbeen proposed as therapy for HRS-1.Liver transplantation remains the gold standard treatment for hepatorenal syndrome. However the lack of donors as well as the very high mortality rate before transplantation limits the advantages of this modality.The poor prognosis of patients with HRS has led many clinicians toconsider the use of standard renal replacement techniques, such as haemodialysis, to be futile in this setting.Bone marrow-derived mesenchymal stem cells can effectively rescue experimental liver failure and contribute to liver regeneration and offer a potentially alternative therapy to organ transplantation for treatment of liver diseases and reversal of HRS.