What is the main precipitating factor in type 1 hepatorenal syndrome (HRS) and how can it be prevented?

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

The main precipitating factor of type 1 HRS is spontaneous bacterial peritonitis (SBP). When this develops in patients with type 2 HRS, the probability of developing type 1 HRS is very high. This may be prevented by antibiotic prophylaxis with Bactrim or fluoroquinolones in patients with a prior history of SBP. Alternatively, patients with type 2 HRS who are on the waiting list may benefit from prophylactic antibiotics, irrespective of whether they have a prior history of SBP.

A randomized controlled trial has shown that the incidence of SBP-related renal failure is reduced if these patients are treated with antibiotics and undergo plasma volume expansion with albumin (1.5 g/kg upon diagnosis and 1 g/kg 48 h later). The incidence of HRS in patients with SBP who received albumin together with antibiotic therapy was 10% compared with an incidence of 33% in patients who did not receive albumin; in addition, hospital mortality rates were also lower in patients who received albumin expansion.


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