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]. 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