Risk factors,diagnosis,and updated classification of hepatorenal syndrome

Hepatorenal syndrome( HRS) is a common complication of decompensated cirrhosis and is traditionally defined as progressive oliguria or anuria,azotemia,dilutional hyponatremia,and hyponatremia,while renal insufficiency without marked organic lesions in the kidney is the typical manifestation of HRS. Recent studies have found that besides the abnormalities in hemodynamics,inflammatory response,oxidative stress,and direct renal tubular toxicity of bile salts are jointly involved in the development and progression of HRS. HRS is not the only renal complication in patients with liver cirrhosis,and it is only a functional form of acute kidney injury( AKI). HRS meeting the criteria for AKI is called HRS-AKI,which is formerly known as HRS-Ⅰ type. For cirrhotic patients with acute kidney disease or chronic kidney disease,if they meet the criteria for HRS,they can be diagnosed with HRS-NAKI,which is formerly known as HRS-Ⅱ type. The most common risk factors for HRS are infection,digestive bleeding,and large-volume paracentesis without transfusion of human serum albumin for volume expansion.