الفهرس 
Hepatorenal syndrome
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Abstract
Summary & Conclusions
Hepatorenal syndrome is a unique form of acute kidney injury
seen in patients with acute liver failure or chronic liver disease in absence
of any other identifiable cause of renal failure.
Despite of good pathophysiological understanding and better
available therapeutic options for management of hepatorenal syndrome, it
is still associated with significant morbidity and mortality. Liver
transplantation forms the cornerstone for the management of hepatorenal
syndrome.
Several meta-analyses that evaluated vasoconstrictor therapies for
HRS did not show any significant reduction in mortality without liver
transplantation.
N-acetyl-L-cysteine (NAC) is known as an antioxidant that acts
directly and/or by increasing intracellular glutathione (GSH), especially on
hepatic tissue.
N-acetyl cysteine potentially has many clinical uses in the
intensive care patient. It has been used to reduce the risk of hepatotoxicity
associated with paracetamol, chloroform, carbon tetrachloride and
potassium permanganate, nephrotoxicity caused by radiographic contrast
agents, cardiotoxicity.
When used to treat severe alcoholic hepatitis, i.v. acetylcysteine
serves as an antioxidant and glutathione source. Improvement in patients
with hepatorenal syndrome was also noted.