Abstract
Background A 35-year-old man with alcoholic cirrhosis, ascites and alcoholic hepatitis presented with new-onset renal insufficiency of unclear etiology after recovery from an episode of gastrointestinal bleeding. Renal function continued to worsen after cessation of diuretic therapy and initiation of volume resuscitation.
Investigations Physical examination, abdominal ultrasound, liver tests, basic metabolic panel, abdominal paracentesis, renal function tests, 24-h urine collections.
Diagnosis Type 1 hepatorenal syndrome (HRS).
Management Intravascular volume resuscitation with normal saline and albumin followed by oral midodrine plus subcutaneous octreotide therapy. This regimen was continued until improvement and subsequent normalization of the serum creatinine.
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References
Arroyo V et al. (1996) Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. Hepatology 23: 164–176
Ginés A et al. (1993) Incidence, predictive factors, and prognosis of hepatorenal syndrome in cirrhosis. Gastroenterology 105: 229–236
Arroyo V et al. (2002) Hepatorenal syndrome in cirrhosis: pathogenesis and treatment. Gastroenterology 122: 1658–1676
Wong F and Blendis L (2001) New challenge of hepatorenal syndrome: prevention and treatment. Hepatology 34: 1242–1251
Runyon BA et al. (2004) Management of adult patients with ascites due to cirrhosis. Hepatology 39: 841–856
Esrailian E et al. (2003) Octreotide/midodrine therapy significantly improves survival in type 1 hepatorenal syndrome: analysis of 53 treated patients and 21 controls. [abstract #525] Gastroenterology 124 (Suppl): A718
Dudley FJ et al. (1986) Hepatorenal syndrome without avid sodium retention. Hepatology 6: 248–251
Gonwa TA et al. (1995) Impact of pretransplant renal function on survival after liver transplantation. Transplantation 59: 361–365.
Gonwa TA et al. (1991) Long-term survival and renal function following liver transplantation in patients with and without hepatorenal syndrome—experience in 300 patients. Transplantation 91: 428–430
Gulberg V et al. (1999) Long-term therapy and retreatment of hepatorenal syndrome type 1 with ornipressin and dopamine. Hepatology 30: 870–875
Duhamel C et al. (2000) Hepatorenal syndrome in cirrhotic patients: terlipressine is a safe and efficient treatment; propranolol and digitalic treatments: precipitating and preventing factors? Am J Gastroenterol 95: 2984–2985
Moreau R et al. (2002) Terlipressin in patients with cirrhosis and type 1 hepatorenal syndrome: a retrospective multicenter study. Gastroenterology 122: 923–930
Angeli P et al. (1999) Reversal of type 1 hepatorenal syndrome with the administration of midodrine and octreotide. Hepatology 29: 1690–1697
Guevara M et al. (1998) Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: effects on renal function and vasoactive systems. Hepatology 28: 416–422
Wong F et al. (2004) Midodrine, octreotide, albumin, and TIPS in selected patients with cirrhosis and type 1 hepatorenal syndrome. Hepatology 40: 55–64
Acknowledgements
We would like to acknowledge Dr TB Reynolds as an inspirational teacher and pioneer in the fields of hepatology and nephrology. His lasting personal and professional influence on the authors is profound, and his contributions to academic medicine are legendary.
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Esrailian, E., Runyon, B. Alcoholic cirrhosis-associated hepatorenal syndrome treated with vasoactive agents. Nat Rev Nephrol 2, 169–172 (2006). https://doi.org/10.1038/ncpneph0114
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DOI: https://doi.org/10.1038/ncpneph0114