Patients with advanced cirrhosis and ascites often develop a peculiar form of renal failure in the absence of clinical, laboratory or histologic causes of renal dysfunction.<sup>12 Bataller R., Ginès P., Guevara M. , e al. Hepatorenal syndrome Semin Liver Dis 1997 ;  17 : 233  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> This condition is known as hepatorenal syndrome (HRS). The functional origin of HRS was suggested when renal specimens from these patients showed minimal histologic changes and was further confirmed by studies showing that kidneys from cirrhotic patients with HRS regained a normal function when transplanted to patients with chronic renal failure and no liver disease, and that renal failure was reversible after liver transplantation.<sup>40 Iwatsuki S., Popovtzer M.M., Corman J.L. , e al. Recovery from “hepatorenal syndrome” after orthotopic liver transplantation N Engl J Med 1969 ;  280 : 1367

Cliccare qui per andare alla sezione Riferimenti, 43 Koppel M.H., Coburn J.N., Mims M.M. , e al. Transplantation of cadaveric kidneys from patients with hepatorenal syndrome. Evidence for the functional nature of renal failure in advanced liver disease N Engl J Med 1969 ;  289 : 1155

Cliccare qui per andare alla sezione Riferimenti, 69 Shear L., Kleinerman J., Gabuzda G.J. Renal failure in patients with cirrhosis of the liver: Clinical and pathological characteristics Am J Med 1965 ;  39 : 184  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Subsequent investigations consistently demonstrated that hypoperfusion of the kidneys caused by marked renal vasoconstriction is the major mechanism underlying HRS.<sup>16 Epstein M., Berck D.P., Hollemberg N.K. , e al. Renal failure in the patient with cirrhosis. The role of active vasoconstriction Am J Med 1970 ;  49 : 175  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> In the last two decades, a new pathophysiologic explanation of this syndrome has been proposed, linking the changes in systemic circulation and the activity of the endogenous vasoactive system that are characteristic of these patients to the development of renal hypoperfusion.<sup>12 Bataller R., Ginès P., Guevara M. , e al. Hepatorenal syndrome Semin Liver Dis 1997 ;  17 : 233  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 53 Moore K. The hepatorenal syndrome Clin Sci (Colch) 1997 ;  92 : 433

Cliccare qui per andare alla sezione Riferimenti</sup> These advances have helped in the design of promising new therapeutic strategies in the management of HRS. This article reviews the pathogenesis, clinical features, and management of HRS in patients with cirrhosis.