Emphasis on the basic and clinical research on hepatorenal syndrome

Hepatorenal syndrome( HRS) is one of the most severe complications of decompensated cirrhosis. Splanchnic arterial vasodilation in patients with advanced liver cirrhosis and the reduction in cardiac output due to cirrhotic cardiomyopathy may trigger the reduction in effective circulating blood volume,the activation of endogenous vasoconstrictor systems,and significant contraction of renal blood vessels;meanwhile,impairment in renal autoregulation of blood flow may finally lead to the reductions in renal blood flow and glomerular filtration rate. Systemic inflammation also plays an important role in the pathogenesis of HRS. The treatment of HRS should start as soon as it is diagnosed. In the past,HRS was considered“functional”renal insufficiency,while at present,it is considered a spectrum of diseases gradually changing from functional renal insufficiency to varying degrees of parenchymal damage. As there are still no suitable animal models of HRS,current investigations of the pathophysiology of HRS and related pharmacological research mainly rely on clinical studies,which brings difficulties in further understanding the natural history and pathophysiology of HRS. This article reviews the recent advances in the basic and clinical research on HRS and related difficulties.