Definition:
Auftreten einer Niereninsuffizienz bei schwerer Lebererkrankung und fehlender erkennbarer anderer Ursache
Funktionellen Einschränkung der Nierenfunktion bei schwerer Lebererkrankung trotz genügender Flüssigkeitszufuhr (nach Auschluss von anderen Ursachen)

Mortalität:
Mortalität 95%, mittleres Überleben wenige Wochen

Entstehung:
renale Vasokonstriktion bei arterieller Vasodilatation vorab im Splanchnicusgebiet relative arterielle Unterfüllung

Verschiedene Mediatoren:
Angiotensin-Reninsystem
Sympathisches Nervensystem
Folge Reduktion renale GFR

Therapie:
keine etablierte Therapie bei irreversiblem Leberversagen
kurzfristige Besserung mit Vasokonstriktoren und Plasmaexpansion belegen Theorie
Langfristig Lebertransplantation

Literatur:
Reversibility of Hepatorenal Syndrome by Prolonged Administration of Ornipressin and Plasma Volume Expansion Mónica Guevara et.al. HEPATOLOGY 1998;27:35-41
"Hepatorenal syndrome is caused by a marked vasoconstriction of the renal circulation. It is suggested that the renal vasoconstriction is related to an overactivity of vasoconstrictor systems secondary to a vasodilation of the arterial circulation that causes a reduction in effective arterial blood volume. To test this hypothesis, 16 cirrhotic patients with hepatorenal syndrome were treated with a combination of ornipressin, a potent vasoconstrictor agent, and plasma volume expansion with albumin to improve effective arterial blood volume. A 3-day treatment was associated with a normalization of the overactivity of renin-angiotensin and sympathetic nervous systems, a marked increase in atrial natriuretic peptide levels, and only a slight improvement in renal function. However, when ornipressin and albumin were administered for 15 days, a remarkable improvement in renal function was observed, with normalization of serum creatinine concentration, a marked increase in renal plasma flow and glomerular filtration rate, and a persistent suppression in the activity of vasoconstrictor systems. In 3 of 8 patients on 15-day therapy treatment had to be discontinued because of ischemic complications. In conclusion, the decrease in effective arterial blood volume and the activation of vasoconstrictor systems play a crucial role in the pathogenesis of hepatorenal syndrome"