• Elina Manzhalii Bogomolets National Medical University, PhD, docent




hepatorenal syndrome, treatment, pathogenesis, acute liver failure, decompensated liver cirrhosis


Introduction. The choice of treatment tactics and the study of the pathogenesis of HRS as a pathological condition of the disease is important to prevent the development of complications in all body systems. After all, HRS as a syndrome manifests itself as a direct lesion on the excretory system, in particular on the kidneys, and with a further risk of developing renal failure. Patients with chronic liver diseases are especially sensitive to the occurrence of HRS.
Goal. Analyze the causal relationship of the occurrence and development of HRS and generalize the treatment strategy based on evidence-based medicine.
Materials and methods. Bibliographic – a theoretical analysis is carried out and a generalization of literature data is carried out. Description and analysis were used in the research.
Results and its discussion. Scientists differentiate the main criteria for GDS as follows. Serum creatinine levels greater than 133 μmol / L; there is no decrease in serum creatinine levels below 133 μmol / l after a twoday discontinuation of diuretics against the background of albumin infusion therapy (the recommended dose of albumin is 1 g / kg of body weight per day to a maximum of 100 g / day); the absence of other reasons for the development of renal failure: shock, sepsis, multiple organ failure, hypovolemia due to extrarenal losses, the use of nephrotoxic agents; absence of parenchymal kidney diseases, manifested by proteinuria more than 500 mg / day, microhematuria (more than 50 erythrocytes in the field of view) and / or changes in the structure and vascular architectonics of the kidneys on ultrasound; the presence of CB with ascites [12].
Conclusions. Monitoring the patient’s indicators, prescribing treatment tactics depending on the type of HRS makes it possible to stabilize the patient’s condition.


1. Sood. J Clin Exp Hepatol. 2019;9:484. Wolf. Medscape. emedicine.medscape.com/ article/185856-overview?src=emailthis#a4.
2. Манжалій А. Г., Никула Т. Д. Гепаторенальний синдром у хворих з цирозом печінки: питання діагностики та лікування // Актуальні проблеми нефрології . — К. «Національний медичний університет імені О. О. Богомольця», 2017 – № 4. – C. 35 – 45.
3. Бакулин И.Г., Варламичева А.А. Гепаторенальный синдром: практические рекомендации по диагностике и лечению // Журнал Альманах клинической медицины Вып. академии, 2004. — 96 с.
4. Стельмащук В.П. Гепаторенальний синдром. // Раціональна фармакотерапія хронічних захворювань печінки. Довідник для практикуючих лікарів. Під загальною редакцією Щербиніної М.Б. – К.: ТОВ «Бібліотека «Здоровя України». – 2015. – С.292-301.
5. Маммаев С.Н. Гепаторенальный синдром: критерии диагноза и лечение // Клинические перспективы гастроэнтерологии, гепатологии.- 2015.- №2 — С. 11-17.
6. Martinez M.O., Harlan S., Renuga V., et al. Hepatorenal Syndrome: Are We Missing Some Prognostic Factors? // Dig. Dis. Sci. – 2011.
7. Лопаткина Т.Н., Краснова Т.Н. Поражение почек при хронических заболеваниях печени // Клиническая гепатология. – 2016. – № 3. – С. 15-21.
8. Пиманов С.И. Новая концепция гепаторенального синдрома // СопвШит Medicum. Гастроэнтерология. – 2008. – №8. – С. 67-72.
9. Wadei H.M., Mai M.L., Ahsan N., Gonwa T.A. Hepatorenal Syndrome: Pathophysiology and Management // Clin. J. Am. Soc. Nephrol.- 2006.- n. 1.- P. 1066- 1079.
10. Wu X.X., Zheng Z.X., Liu Z.L., et al. Correlative study between angiotensin-converting enzyme gene polymorphism and hepatorenal syndrome. 2005; 17(2): 121-123
11. Santos R.A., Simoes e Silva A.C., Marie C., et al.1-7 Angiotensin is an endogenous ligand for the G protein-coupled receptor // Mas. Proc. Natl. Acad. Sci. USA. – 2003. – Vol. 100. – P. 8258- 8263.
12. Salerno F., Gerbes A., Gines P., et al. Diagnosis, prevention and treatment of the hepatorenal syndrome in cirrhosis: A consensus workshop of the international ascites club. // Gut. – 2007, Vol.56. – P. 1310-1318.
13. Поликарпова Т.С., Мазурчик Н.В., Огурцов П.П. и др. Гепаторенальный синдром: критерии диагностики, подходы к терапии и возможности терлипрессина // Клиническая фармакалогия и терапия. – 2009. – № 18 (4).
14. Лабудзинский Д.О., Гавриленко Д.И., Бака Е.М., Э.Г. Манжалий. Подход к терминальной стадии заболевания печени как к многогранной проблеме // Мат. конф. Европейской организации по изучению печени (EASL) // Здоров’я України. – 2015. – №4 (38). – С. 44-46.
15. Wong F. The evolving concept of acute kidney injury in patients with cirrhosis // Nat. Rev. Gastroenterol. Hepatol. – 2015. – Vol. 12. – P.711-719. [Medline].
16. Srivastava S., Madan K., Prakash S., et al. A Randomized Controlled Trial of Terlipressin and Albumin Versus Albumin, Low Dose Dopamine and Frusemide in Hepatorenal Syndrome // J. Clin. Exp. Hepatol. – 2011. – Vol. 1 (Suppl. 1). – P. 23-24.
17. Angeli P. Terlipressin for Hepatorenal syndrome: Novel strategies and future perspectives // Front. Gastrointest. Res. – 2011. – Vol. 28. – P. 189-97.
18. Sanyal A.J., Boyer Т., Garcia-Tsao G. A Randomized, prospective, double-blind, placebo-controlled trial of terlipressin for type 1 hepatorenal syndrome // Hepatology. – 2007. – Vol. 44. – P. 694.
19. Velez JC, Nietert PJ. Therapeutic response to vasoconstrictors in hepatorenal syndrome parallels increase in mean arterial pressure: a pooled analysis of clinical trials // Am. J. Kidney Dis. – 2011. – Vol. 58. – P. 928.
20. Gines P., Guevara M. Good news for hepatorenal syndrome // Hepatology. – 2002 Vol. 36. – P. 504-506.
21. Boyer T.D., Sanyal A.J., Garcia-Tsao G., et al. Predictors of response to terlipressin plus albumin in hepatorenal syndrome (HRS) type 1: Relationship of serum creatinine to hemodynamics // J. Hepatol. – 2011. – Vol. 55. – P. 315-321.22. Uriz J., Gardenas A., Sort P. et al. Terlipressin plus albumin infusion: an effective and safe therapy of hepatorenal syndrome // J. Hepatol. – 2000. – Vol. 33. – P. 43–48.
23. Kidney International (2009) 76, 811 – 812. doi:10.1038/ki.2009.282
24. Sohn EJ, Kang DG, Lee HS. Protective effects of glycyrrhizin on gentamicin- induced acute renal failure in rats. Pharmacol Toxicol. 2003 Sep;93(3):116-22
25. Curdenas A. Hepatorenal Syndrome: A Dreaded Complication of End-Stage Liver Disease // Am. J. Gastroenterol. – 2005. – Vol. 100. – P. 460-467.
26. Wong F., Pantea L., Shinderman K. Midodrine, octreotide, albumin, and TIPS in selected patients with cirrhosis and type 1 hepatorenal syndrome // Hepatology. – 2004. – Vol. 40. – P. 55–64.
27. Vilar Gomez E, Sanchez Rodriguez Y, Torres Gonzalez A, Calzadilla Bertot L, Arus Soler E, Martinez Perez Y, Yasells Garcia A, Abreu Vazquez Mdel R. Viusid, a nutritional supplement, increases survival and reduces disease progression in HCV-related decompensated cirrhosis: a randomised and controlled trial. BMJ Open. 2011 Jan 1;1(2):e000140. doi:10.1136/bmjopen-2011-000140. PubMed PMID: 22021873; PubMed Central PMCID:PMC3191588.
28. Yoshihiro Matsumoto. Antiviral Activity of Glycyrrhizin against Hepatitis C Virus In Vitro. Published online 2013 Jul 18. doi: 10.1371/journal.pone.0068992.



How to Cite

Manzhalii Е. (2021). HEPATORENAL SYNDROME. DIFFERENTIATED APPROACH TO TREATMENT. Actual Problems of Nephrology, (29), 21–28. https://doi.org/10.37321/nefrology.2021.29-02