Hepatorenal Syndrome - Diagnosis and Management Summary Who gets HRS? • Decompensated cirrhosis • Typically with existing ascites • HypoNa+ Often present, higher risk Often will have a precipitant: Medications, Alcohol abuse, Bacterial infection Mainstay of treatment in HRS-AKI is vasoactive therapy + albumin TERLIPRESSIN Mechanism: • Vasopressin agonist • Acts on V1 receptors • Splanchnic/extrarenal vasoconstriction Dose: 2-12mg/24h (infusion) Side effects: Diarrhea, circulatory overload, CV ischemia NOREPINEPHRINE Mechanism: • agonist of a1 (↑ vasoconstriction), ß1 (↑ cardiac output) Dose: 0.5-3mg/h (infusion) Typically requires ICU May be as effective as terlipressin though limited data MIDODRINE+OCTREOTIDE Mechanisms: • Midodrine - Selective a1 agonist, Splanchnic vasoconstriction • Octreotide - Inhibits release of glucagon, which is a splanchnic vasodilator Dose: • Midodrine 5-15mg PO TID • Octreotide 50mcg/hr infusion (or 100-200mcg SQ TID) ALBUMIN Should be given regardless of vasoconstrictor used Dose: 20-50 g/day of 25% albumin Mechanism: • ↑ intravascular volume • Maintains cardiac output • Proposed anti-oxidant, anti-inflammatory effects - Dr. Hersh Shroff @HershShroff #Hepatorenal #Syndrome #HRS #Diagnosis #Management #treatment
