Hepatorenal syndrome: current insights and future perspectives

Hepatorenal syndrome (HRS), a rare but devastating disease characterized by potentially reversible damage to kidney function, remains a significant health challenge in patients with advanced cirrhosis. The high financial burden associated with this disease due to patient hospitalizations is worrisome. Updates on the disease's definition, classification, and pathophysiology have led to the emendation of diagnostic criteria to enhance the early detection of cases. Novel studies propose a more complex pathophysiology of HRS than previously thought. Accurate HRS diagnosis continues to be a challenge, based on the exclusion of differentials, since novel biomarkers that could help definitively diagnose and predict clinical outcomes have not been fully explored. The ultimate treatment of HRS is liver transplant. In preparation for liver transplant, therapeutic treatment with vasoconstrictor drugs to help counteract splanchnic arterial vasodilation and expansion of plasma volume by intravenous albumin infusion is helpful. The recent discovery of novel biomarkers, potentially useful in early disease diagnosis, predicting treatment choice, and clinical outcome, needs to be further explored to enhance understanding of the disease.