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Kidney Week

Educational Symposium

Hepatorenal Syndrome Type 1: Pathophysiology and Management

November 08, 2019 | 06:45 AM - 07:45 AM

Location: Marquis Ballroom, Salon 5, Marriott Marquis

Session Description

Hepatorenal syndrome (HRS) type 1 is a form of acute kidney dysfunction that develops in patients with acute liver failure or advanced, end-stage cirrhosis. AKI in patients with these types of liver disease can be due to volume depletion with prerenal physiology, acute tubular injury from nephrotoxins, ischemia, toxic bile acids, sepsis, or urinary obstruction. HRS type 1 is therefore a diagnosis of exclusion. When present, this syndrome is associated with significant morbidity and mortality.

The pathophysiology underlying AKI with HRS type 1 is characterized by marked vasoconstriction of the renal arteries in the absence of structural kidney injury on histopathology. Disturbances in circulatory function, which occur from splanchnic circulation vasodilation associated with severe liver failure, promote activation of compensatory vasoconstrictor factors, including the sympathetic nervous system, renin-angiotensin-aldosterone system, and other vasopressors. In addition, a systemic inflammatory reaction associated with advanced cirrhosis may also play a role. A number of factors may trigger HRS type 1, including bacterial infections such as spontaneous bacterial peritonitis (SBP), gastrointestinal hemorrhage, and excessive diuresis.

Once other causes of AKI have been excluded, acute medical management of HRS type 1 includes judicious volume repletion with IV albumin, treatment of associated infections (i.e., SBP), and treatment with vasopressors to reduce splanchnic vasodilatation. For patients with severe AKI, acute renal replacement therapy may be provided when appropriate. Ultimately, liver transplantation is the best option for patients who qualify.

Support is provided by an educational grant from Mallinckrodt LLC.

Learning Objective(s)

  • Describe the major pathophysiological mechanisms underlying HRS type 1
  • Discuss the therapeutic options available to treat HRS type 1

Learning Pathway(s)

  • Acute Kidney Injury

Moderator

  • Justin Miles Belcher, MD, PhD

Presentations

  • Introduction
    06:45 AM - 06:55 AM
    Justin Miles Belcher, MD, PhD
  • Pathophysiology Underlying HRS Type 1
    06:55 AM - 07:15 AM
    Luis A. Juncos, MD, FASN
  • Management Options for Patients with HRS Type 1
    07:15 AM - 07:35 AM
    Hani Wadei, MD, FASN
  • Questions and Answers
    07:35 AM - 07:45 AM