INVESTIGATING HEPATORENAL SYNDROME (HRS) IN PATIENTS WITH CHRONIC LIVER DISEASE: ENHANCING DIAGNOSTIC ACCURACY AND TREATMENT STRATEGIES

Abstract

Background: Hepatorenal syndrome (HRS) is a serious complication of advanced liver disease, characterized by the rapid deterioration of kidney function in the absence of intrinsic renal pathology. This study aimed to investigate the prevalence, diagnostic accuracy, and treatment outcomes of HRS in patients with chronic liver disease.

Methods: This prospective cohort study included 150 patients with chronic liver disease assessed for HRS at a tertiary care center. Patients were classified into Type 1 or Type 2 HRS based on clinical criteria and laboratory findings. Diagnostic accuracy of new biomarkers and treatment responses to vasoconstrictors and liver transplantation were evaluated. Exclusion criteria included intrinsic renal pathology, recent renal replacement therapy, and significant comorbid conditions.

Results: Of the 150 patients, 45 were diagnosed with HRS (20 Type 1 and 25 Type 2). The median serum creatinine level was 2.8 mg/dL, and the average glomerular filtration rate (GFR) was 24 mL/min/1.73m2. New biomarkers demonstrated an 85% diagnostic accuracy for HRS. Treatment with vasoconstrictors improved renal function in 66% of patients, while 33% benefited from liver transplantation. The overall mortality rate among HRS patients was 40%.

Conclusion: The study highlights the severe impact of HRS on renal function and patient outcomes, with Type 1 HRS associated with a poorer prognosis compared to Type 2 HRS. New biomarkers show promise for early diagnosis, potentially improving management strategies. Vasoconstrictors are effective for managing Type 1 HRS, and liver transplantation remains a critical option for advanced cases. The high mortality rate underscores the need for prompt diagnosis and tailored treatment approaches. Further research should focus on optimizing diagnostic and therapeutic strategies to enhance patient outcomes in HRS.

Keywords: Hepatorenal syndrome, chronic liver disease, renal impairment, biomarkers, vasoconstrictors, liver transplantation