Le syndrome hépatorénal

There has been a real progress of knowledge about the physiopathology of hepatorenal syndrome (HRS). HRS is closely related to haemodynamic disturbances due to severe hepatic failure. HSR may be prevented and treated based on the correction of physiopathological disturbances. Avoiding nephrotoxic agents and early treatment of hepatic disease complications are critical for HRS prevention. Type-1 HRS are treated by vasopressors, fluid expansion with albumin, and in selected patients by the use of tranjugular intrahepatic portosystemic stent shunt (TIPSS) or extracorporeal renal or hepatic dialysis. In type-2 HRS, the gold standard is ascitis withdrawal associated with albumin infusion. Since HRS is the landmark of a severe and lifetreatening hepatic disease, patients are scheduled for hepatic transplantation when eligible, whatever the type of HRS. Palliative treatment aims to maintain patient status until hepatic transplant is available.