PATHOPHYSIOLOGY OF HEPATORENAL SYNDROME: A COMPREHENSIVE REVIEW

Аннотация

Hepatorenal Syndrome (HRS) is a grave complication of advanced liver disease, characterized byfunctional renal failure inthe absence of underlying structural kidney pathology. The pathogenesis of HRS is multifactorial and deeply intertwined with the complex hemodynamic changes that occur in cirrhosis. The hallmark features include splanchnic arterial vasodilation, systemic circulatory dysfunction, renal vasoconstriction, and impaired renal autoregulation. Neurohormonal activation, particularly the renin-angiotensin-aldosterone system (RAAS), sympathetic nervous system (SNS), and non-osmotic vasopressin release, plays a pivotal role. Emerging evidence highlights the role of systemic inflammation, bacterial translocation, and immune dysregulation in the progression of renal dysfunction in cirrhosis. This article explores the detailed pathophysiology of HRS, from its historical development to molecular mechanisms, and discusses how this understanding informs clinical management and therapeutic development. Keywords: Hepatorenal syndrome; Pathophysiology; Cirrhosis; Renal vasoconstriction; Splanchnic vasodilation; Systemic inflammation; Portal hypertension; Neurohormonal activation; Nitricoxide; RAAS;AKI in cirrhosis.