Treatment of Hepatorenal Syndrome (HRS-AKI) in Cirrhosis

Hepatorenal syndrome presenting as acute kidney injury (HRS-AKI) in patients with cirrhosis carries high short-term mortality. Appropriate management requires timely consideration of all available therapeutic pathways, including evaluation for transplantation.

Clinical Scenario

This protocol addresses HRS-AKI occurring in the setting of cirrhosis, where both liver and kidney function must be considered together when planning the treatment strategy.

Treatment Approach

Definitive management focuses on restoring liver function as the ultimate therapeutic goal. The protocol specifies how and when transplant evaluation should be initiated, and under which circumstances a combined organ approach becomes relevant.

Full criteria, sequencing, and clinical decision points are available in the complete protocol below.

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References

DOI: 10.1002/hep.31884

Restoring liver function by LT is the ultimate therapy for HRS-AKI.
All patients with cirrhosis and AKI should be considered for urgent LT evaluation given the high short-term mortality even in responders to vasoconstrictors.
Simultaneous liver-kidney transplantation may be necessary for patients who are not expected to recover kidney function posttransplantation.

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