What can be concluded from studies regarding systemic vasoconstrictors for the treatment of hepatorenal syndrome?

Updated: Oct 16, 2017
  • Author: Deepika Devuni, MD; Chief Editor: BS Anand, MD  more...
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These studies demonstrate several important points. First, vasoconstrictors play an important role in the treatment of HRS, but further work is needed to identify the ideal agent and to determine if the addition of albumin is necessary. Another important conclusion of these studies is that patients may maintain relatively preserved renal function once therapy is discontinued. This suggests that if the precipitating factor, such as spontaneous bacterial peritonitis (SBP), is not readily identified, an irreversible decline in renal function ensues.

N-acetylcysteine (NAC): In 1999, the Royal Free group reported their experience with NAC for the treatment of HRS. This was based on experimental models of acute cholestasis, in which administration of NAC resulted in an improvement in renal function. Twelve patients with HRS were treated with intravenous NAC, without any adverse effects, and the survival rates were 67% and 58% at 1 month and 3 months, respectively (this included 2 patients who received liver transplantation after improvement in renal function). The mechanism of action remains unknown, but this interesting study encourages further optimism for medical treatment of a condition that once carried a hopeless prognosis in the absence of liver transplantation. Controlled studies with longer follow-up may help answer these pressing questions.

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