Management of hepatorenal syndrome Halit Ziya Dundar, Tuncay Yılmazlar citation



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PREVENTION

Prevention of HRS is important since it develops with a constant frequency in cases of SBP and alcoholic hepatitis. It is possible to prevent HRS if SBP is urgently diagnosed and treated. Albumin infusion may help to prevent HRS when SBP develops. Albumin infusion is started together with antibiotherapy with an initial dose of 1.5 g/kg at the time of diagnosis of infection and albumin infusion is repeated after 48 h with a dose of 1 g/kg[23,100]. The incidence of renal dysfunction is decreased when compared to patients who are not treated with albumin (8% vs 31%) and mortality is also decreased (16% vs 35%)[100]. Norfloxacin is recommended in selected patients with cirrhosis and ascites. Four hundred mg/day dose of oral norfloxacin in a one year time period was found to decrease SBP development (7% vs 61%), decrease HRS development (28% vs 41%) and improve survival at three months (94% vs 62%) and one year (60% vs 48%)[100,101]. In a study investigating whether pentoxifylline is beneficial or not, significant benefit with 1200 mg/d pentoxifylline was observed when compared with placebo[102] but a meta-analysis revealed that pentoxifylline has no benefit in HRS[103].


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P- Reviewer: Alam S, El-Shabrawi MH, Hu R, Merli M

S- Editor: Ji FF L- Editor: Roemmele A E- Editor: Lu YJ


Table 1 Criteria for diagnosis of hepatorenal syndrome in cirrhosis

Cirrhosis with ascites


Serum creatinine > 1.5 mg/dL (133 mol/L)


Absence of shock


Absence of hypovolemia as defined by no sustained improvement of renal function (creatinine decreasing to < 133 mol/L) following at least 2 d of diuretic withdrawal (if on diuretics) and volume expansion with albumin at 1 g/kg per day up to a maximum of 100 g/d


No current or recent treatment with nephrotoxic drugs


Absence of parenchymal renal disease as defined by proteinuria < 0.5 g/d, no microhematuria (< 50 red cells/high powered field) and normal renal ultrasonography




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