EPIDEMIOLOGY OF HEPATORENAL SYNDROME: CURRENT DATA
DOI:
https://doi.org/10.32782/health-2023.4.6Keywords:
liver, kidneys, hepatorenal syndrome, liver cirrhosis, prevalence, etiologyAbstract
Hepatorenal syndrome is a unique form of functional renal failure due to decreased renal blood flow that usually occurs in kidneys that are histologically intact. Research on predictors of hepatorenal syndrome (HRS) is scarce, and most studies are limited by difficulties in establishing the diagnosis and changing conceptual understanding of the pathophysiology and definition of HRS. Therefore, the purpose of this study was to analyze the current data on the prevalence and etiology of HRS. Scientific publications of recent years, which are available on the Internet, were observed. It has been established that HRS is usually diagnosed with a marked decrease in glomerular filtration rate and in the absence of established signs of internal kidney diseases, such as hematuria, proteinuria, or ultrasound findings of kidney changes. Accumulating evidence and advances in nephrology led the International Ascites Association to reclassify HRS-1 (a rapidly progressive form of HRS characterized by liver cirrhosis with ascites) as HRS acute kidney injury (HRS-AKI) in 2015, and HRS-2 (slowly progressive a form of HRS commonly associated with refractory ascites) as HRS-NAKI (chronic kidney injury) in 2019. The prevalence of HRS (using the revised diagnostic criteria) in patients with cirrhosis and ascites ranges from 13.0% to 45.8%. Most patients with HRS are about 60 years old. In terms of gender, men predominate, in particular, a number of studies have shown that HRS is diagnosed in more than 70% of men. According to a pooled analysis, alcoholassociated liver cirrhosis was the main etiological factor in 57% of cases of HRS. It has been scientifically proven that cirrhosis of the liver leads to portal hypertension, which causes a number of serious complications, including bleeding from varicose veins of the stomach and, as well as HRS. HRS can occur spontaneously or can be caused by a precipitating factor in > 70% of cases of HRS. The most common provoking factor is spontaneous bacterial peritonitis. Therefore, HRS has a significant prevalence among patients with liver cirrhosis and ascites, and is associated with certain unmodified factors (age, sex).
References
Buccheri S., Da B.L. Hepatorenal Syndrome: Definitions, Diagnosis, and Management. Clinics in liver disease. 2022. № 26(2). Р. 181–201. https://doi.org/10.1016/j.cld.2022.01.002.
Solà E., Ginès P. Renal and circulatory dysfunction in cirrhosis: Current management and future perspectives. J Hepatol. 2010. № 53(6). Р. 1135–1145.
Krag A., Bendtsen F., Henriksen J. H., Møller S. Low cardiac output predicts development of hepatorenal syndrome and survival in patients with cirrhosis and ascites. Gut. 2010. № 59(1). Р. 105–110.
Sersté T., Melot C., Francoz C., et al. Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites. Hepatology. 2010. № 52(3). Р. 1017–1022.
Mandorfer M., Bota S., Schwabl P., et al. Nonselective β blockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis. Gastroenterology. 2014. № 146(7).
Acevedo J., Fernández J., Prado V., et al. Relative adrenal insufficiency in decompensated cirrhosis: Relationship to short-term risk of severe sepsis, hepatorenal syndrome, and death. Hepatology. 2013 № 58(5). Р. 1757–1765
Theocharidou E., Krag A., Bendtsen F., Møller S., Burroughs A.K. Cardiac dysfunction in cirrhosis – does adrenal function play a role? A hypothesis. Liver Int. 2012. № 32(9). Р. 1327–1332.
Weichselbaum L., Gustot T. The Organs in Acute-on-Chronic Liver Failure. Semin Liver Dis. 2016. № 36(2). Р. 174–180.
Albillos A., Lario M., Álvarez-Mon M. Cirrhosis-associated immune dysfunction: distinctive features and clinical relevance. J Hepatol. 2014 № 61. Р. 1385–1396.
Bernardi M., Moreau R., Angeli P., Schnabl B., Arroyo V. Mechanisms of decompensation and organ failure in cirrhosis: From peripheral arterial vasodilation to systemic inflammation hypothesis. J Hepatol. 2015. № 63. Р. 1272–1284.
Ruiz-del-Arbol L., Monescillo A., Arocena C., et al. Circulatory function and hepatorenal syndrome in cirrhosis. Hepatology. 2005. № 42. Р. 439–447.
Bernardi M., Trevisani F., Gasbarrini A., Gasbarrini G. Hepatorenal disorders: role of the renin-angiotensinaldosterone system. Semin Liver Dis. 1994. № 14. Р. 23–34.
Henriksen J.H., Møller S., Ring-Larsen H., Christensen N.J. The sympathetic nervous system in liver disease. J Hepatol. 1998. № 29. Р. 328–341.
Nazar A., Guevara M., Sitges M., et al. LEFT ventricular function assessed by echocardiography in cirrhosis: relationship to systemic hemodynamics and renal dysfunction. J Hepatol. 2013. № 58. Р. 51–57.
Ruiz-del-Arbol L., Urman J., Fernández J., et al. Systemic, renal, and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis. Hepatology. 2003. № 38. Р. 1210–1218.
Chan-Young Jung and Jai Won Chang. Hepatorenal syndrome: Current concepts and future perspectives. Clinical and Molecular Hepatology. 2023. № 29. Р. 891–908.
Barreto R., Fagundes C., Guevara M., et al. Type-1 hepatorenal syndrome associated with infections in cirrhosis: natural history, outcome of kidney function, and survival. Hepatology. 2014. № 59. Р. 1505–1513.
Elia C., Graupera I., Barreto R., et al. Severe acute kidney injury associated with non-steroidal antiinflammatory drugs in cirrhosis: A case-control study. J Hepatol. 2015. № 63. Р. 593–600.
Thabut D., Massard J., Gangloff A., et al. Model for end-stage liver disease score and systemic inflammatory response are major prognostic factors in patients with cirrhosis and acute functional renal failure. Hepatology. 2007. № 46. Р. 1872–1882. DOI: 10.1002/ hep.21920.
Wiest R., Lawson M., Geuking M. Pathological bacterial translocation in liver cirrhosis. J Hepatol. 2014. № 60. Р. 197–209.
Angeli P., Garcia-Tsao G., Nadim M.K., Parikh C.R. News in pathophysiology, definition and classification of hepatorenal syndrome: A step beyond the International Club of Ascites (ICA) consensus document. Journal of hepatology. 2019. № 71(4). Р. 811–822. https://doi.org/10.1016/j.jhep.2019.07.002.
Solé C., Solà E., Huelin P., et al. Characterization of inflammatory response in hepatorenal syndrome: Relationship with kidney outcome and survival. Liver Int. 2019. № 39. Р. 1246–1255. DOI: 10.1111/ liv.14037.
Shah N., Mohamed F.E., Jover-Cobos M., et al. Increased renal expression and urinary excretion of TLR4 in acute kidney injury associated with cirrhosis. Liver Int. 2013. № 33. Р. 398–409. DOI: 10.1111/ liv.12047.
Shah N., Dhar D., El Zahraa Mohammed F., et al. Prevention of acute kidney injury in a rodent model of cirrhosis following selective gut decontamination is associated with reduced renal TLR4 expression. J Hepatol. 2012. № 56. Р. 1047–1053. DOI: 10.1016/j.jhep.2011.11.024.
Rivolta R., Maggi A., Cazzaniga M., et al. Reduction of renal cortical blood flow assessed by Doppler in cirrhotic patients with refractory ascites. Hepatology. 1998. № 28. Р. 1235–1240. DOI: 10.1002/ hep.510280510.
Mindikoglu A.L., Dowling T.C., Wong-You-Cheong J.J., et al. A pilot study to evaluate renal hemodynamics in cirrhosis by simultaneous glomerular filtration rate, renal plasma flow, renal resistive indices and biomarkers measurements. Am J Nephrol. 2014. № 39. Р. 543–552.
Singh R.R., Walia R., Sachdeva N., Bhalla A., Singh A., Singh V. Relative adrenal insufficiency in cirrhotic patients with ascites (hepatoadrenal syndrome). Dig Liver Dis. 2018. № 50. Р. 1232–1237. DOI: 10.1016/j. dld.2018.05.011.
Piano S., Favaretto E., Tonon M., et al. Including Relative Adrenal Insufficiency in Definition and Classification of Acute-on-Chronic Liver Failure. Clin Gastroenterol Hepatol. 2020. № 18. Р. 1188–1196.e3. DOI: 10.1016/j.cgh.2019.09.035.
Kim G., Huh J.H., Lee K.J., Kim M.Y., Shim K.Y., Baik S.K. Relative Adrenal Insufficiency in Patients with Cirrhosis: A Systematic Review and Meta-Analysis. Dig Dis Sci. 2017. № 62. Р. 1067–1079. DOI: 10.1007/s10620- 017-4471-80.
Jang J.Y., Kim T.Y., Sohn J.H., et al. Relative adrenal insufficiency in chronic liver disease: its prevalence and effects on long-term mortality. Aliment Pharmacol Ther. 2014. № 40. Р. 819–826. DOI: 10.1111/apt.12891.
Tsai M.H., Peng Y.S., Chen Y.C., et al. Adrenal insufficiency in patients with cirrhosis, severe sepsis and septic shock. Hepatology. 2006. № 43. Р. 673–681. DOI: 10.1002/hep.21101.
Bornstein S.R. Predisposing factors for adrenal insufficiency. N. Engl. J Med. 2009. № 360. Р. 2328–2339. DOI: 10.1056/NEJMra0804635.
Bräsen J.H., Mederacke Y.S., Schmitz J., et al. Cholemic Nephropathy Causes Acute Kidney Injury and Is Accompanied by Loss of Aquaporin 2 in Collecting Ducts. Hepatology. 2019. № 69. Р. 2107–2119. DOI: 10.1002/ hep.30499.
van Slambrouck C.M., Salem F., Meehan S.M., Chang A. Bile cast nephropathy is a common pathologic finding for kidney injury associated with severe liver dysfunction (published Online First: 2013/03/15). Kidney Int. 2013. № 84. Р. 192–197. DOI: 10.1038/ki.2013.78.
