Management of hepatorenal syndrome



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PREVENTİON

Prevention of HRS is important since it develops with a constant frequency in case of SBP and alcoholic hepatitis. So 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 after 48 hours albumin infusion is repeated with a dose of 1 g/kg[23,100]. Incidence of renal dysfunction is decreased when compared to patients who are not treated with albumin (8% vs 31%) and also mortality is decreased (16% vs 35%)[100]. Norfloxacin is recommended in selected patients with cirrhosis and ascites. Four hundred mg/day dose of oral norfloxacin in one year time period was found to decrease SBP development (7% vs 61%), decrease HRS development (28% vs 41%) and improved survival at three months (94% vs 62%) and one year (60% vs 48%)[100,101]. In a study investigating whether pentoxifyline is beneficial or not it is observed that there is significant benefit with 1200 mg/d pentoxifyline when compared with plasebo[102]. But a meta-analysis revealed that there is no benefit of pentoxifyline on HRS[103].



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P-Reviewer: Alam S, El-Shabrawi MH, Hu R, Merli M S-Editor: Ji FF L-Editor: E-Editor:


Table 1 Criteria for diagnosis of hepatorenal syndrome in cirrhosis

Cirrhosis with ascites

Serum creatinine > 1.5 mg/dL (133 µmol/L)

Absence of shock

Absence of hypovolemia as defined by no sustained improvement of renal function (creatinine decreasing to < 133 µmol/L) following at least 2 d ofdiuretic 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 microhaematuria (< 50 red cells/high powered field), and normal renal ultrasonography

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