What are the treatment options for hepatorenal syndrome in patients with cirrhosis?

Updated: Jul 30, 2018
  • Author: David C Wolf, MD, FACP, FACG, AGAF, FAASLD; Chief Editor: BS Anand, MD  more...
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Answer

Answer

Nephrotoxic medications, including aminoglycoside antibiotics, should be avoided in patients with cirrhosis. Patients with early hepatorenal syndrome may be salvaged by aggressive expansion of intravascular volume with albumin and fresh frozen plasma and by avoidance of diuretics. The use of renal-dose dopamine is not effective.

A number of investigators have employed systemic vasoconstrictors in an attempt to reverse the effects of nitric oxide on peripheral arterial vasodilation. In Europe, administration of IV terlipressin (an analog of vasopressin not available in the United States) improved renal dysfunction in patients with hepatorenal syndrome. [34, 35]

A combination of midodrine (an oral alpha agonist), subcutaneous octreotide, and albumin infusion has also been demonstrated to improve renal function in small cohorts of patients with hepatorenal syndrome. [36]


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