ADVANCES IN MANAGEMENT AND DIAGNOSTIC CRITERIA FOR HEPATORENAL SYNDROME IN CIRRHOSIS
Keywords:
Hepatorenal Syndrome, Acute Kidney Injury, Biomarkers, Terlipressin, Albumin, Diagnostic Gaps, Therapeutic Strategies, Regional Guidelines, Resource-Limited SettingsAbstract
This article examines the therapeutic and diagnostic breakthroughs in hepatorenal syndrome (HRS), a critical consequence of liver cirrhosis marked by fast renal impairment. Recent insights highlight the significance of systemic inflammation in conjunction with hemodynamic abnormalities, altering the comprehension of its etiology. Notwithstanding advancements, obstacles persist in the prompt recognition and efficient management of acute kidney damage (AKI) linked to HRS, which considerably affects patient outcomes. This review consolidates findings from recent diagnostic methods, emphasizing the transition from fixed serum creatinine thresholds to dynamic AKI staging, which facilitates earlier detection and intervention. Investigations into treatments that combine albumin with vasoconstrictors, including terlipressin or norepinephrine, reveal their effectiveness in stabilizing hemodynamics. Complications such as respiratory failure linked to terlipressin in advanced acute-on-chronic liver failure (ACLF) necessitate meticulous evaluation. Significant findings indicate the usefulness of biomarkers such as N-GAL and cystatin C in differentiating functional from structural causes of AKI, however their clinical utilization is still restricted. Liver transplantation is the definitive remedy for HRS-AKI, but renal replacement therapy offers temporary support for urgent cases. This study highlights the necessity of incorporating early diagnosis methods, enhancing treatment tactics, and progressing biomarker research to elevate survival rates for individuals with HRS. These developments furnish physicians and researchers with a basis to tackle existing deficiencies in care and inform future solutions.
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