What are the approach considerations in the treatment of hepatorenal syndrome (HRS)?

Updated: Oct 16, 2017
  • Author: Deepika Devuni, MD; Chief Editor: BS Anand, MD  more...
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Answer

Every attempt should be made to establish a precipitating cause of hepatorenal syndrome (HRS). This is particularly true for type 1 HRS, which rarely occurs spontaneously and may be associated with spontaneous bacterial peritonitis (SBP) in 25% of cases. If renal function does not improve after institution of third-generation cephalosporins for SBP, a follow-up diagnostic paracentesis is recommended 48 hours later.

Patients with HRS should be evaluated for liver transplantation, at a liver transplant center if possible. This may be more applicable for patients with type 2 HRS, who have a longer survival time, as opposed to patients with type 1 HRS, whose survival is extremely short and who may require alternative therapeutic methods (eg, TIPS, vasoconstrictors) as a bridge to transplantation.


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