Abstract
Hepatorenal syndrome (HRS) is a grave complication of end-stage liver disease and is associated with a very high mortality. This case report described a 42-year-old female with advanced alcohol-induced cirrhosis who developed HRS that was initially treated with Midodrine and Octreotide but renal function continued to deteriorate. Vasopressin therapy was added and HRS was successfully reversed. There are few data available on the use of vasopressin for HRS and this case supports its use in treatment of HRS, particularly in countries where the more widely studied Terlipressin is unavailable. This case also demonstrates that a patient failing one medical therapy for HRS may respond to an alternative or adjunctive therapy. Therefore, this should be attempted to increase the patient’s chance of survival.
Highlights
IntroductionHepatorenal syndrome (HRS) is a grave complication of end-stage liver disease and is associated with a very high mortality
Hepatorenal syndrome (HRS) is a grave complication of end-stage liver disease and is associated with a very high mortality. This case report described a 42-year-old female with advanced alcohol-induced cirrhosis who developed HRS that was initially treated with Midodrine and Octreotide but renal function continued to deteriorate
Management of HRS is challenging since the ideal treatment is liver transplantation, which is usually difficult to accomplish in a short timeframe
Summary
Hepatorenal syndrome (HRS) is a grave complication of end-stage liver disease and is associated with a very high mortality. It is characterized by arterial vasodilation of the splanchnic vessels leading to pronounced renal vasoconstriction, marked reduction in renal blood flow and glomerular filtration rate [1]. Type 2 causes a more slowly progressive renal failure, typically over months with a median survival of about six months [2]. In Europe, the Vasopressin analogue Terlipressin, has been used successfully This medication is costly and not available in many countries, including North America [1]. We present a case of Type 1 Hepatorenal Syndrome that is successfully reversed with vasopressin
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