Syndrome hépatorénal : prévention et traitement

Hepatorenal syndrome (HRS) is a life-threatening complication in cirrhosis. Its evolution is often fatal. Type-1 HRS is characterized by a rapidly progressive renal failure, while type-2 HRS shows a steady or slowly progressive renal failure. Precipitating factors are now identified and curable. Liver transplantation remains the treatment of choice. New effective treatments increase the number of patients reaching transplantation alive. First of all, association between vasoconstrictors (terlipressin or norepinephrin) and albumin shows a great rate of reversal of type-1 HRS. Other treatments, when that first-line treatment fails, should be considered. The aim of this review is to expose the different therapeutic options available and suggest a reasonable management for those patients from now on eligible for ICU admission.