Managing Hepatorenal Syndrome in Viral Hepatitis: A New Era of Treatment Strategies

This review examines hepatorenal syndrome (HRS) in viral hepatitis, outlining its evolution into a complex clinical challenge. It summarizes the etiology, epidemiology, and dual classification of HRS into rapidly progressive type 1 (HRS-AKI) and slower type 2 forms, noting the diagnostic challenges in differentiating HRS from other acute kidney injuries. The review discusses the pathophysiological mechanisms—namely systemic vasodilation and compensatory renal vasoconstriction—and current treatment strategies, including early intervention with albumin and vasoconstrictors (terlipressin, norepinephrine, midodrine/octreotide), renal replacement therapy, and liver transplantation. It also highlights emerging treatments such as TIPS and artificial liver support systems, underscoring the need for prompt, multidisciplinary management to improve outcomes.