C. Terlipressin – Explanation
This patient has developed hepatorenal syndrome
Hepatorenal syndrome: management
The management of hepatorenal syndrome (HRS) is notoriously difficult. The ideal treatment is liver
transplantation but patients are often too unwell to have surgery and there is a shortage of donors
Hepatorenal syndrome has been categorized into two types:
| Type 1 HRS | Type 2 HRS |
| • Rapidly progressive • Doubling of serum creatinine to > 221 μmol/L or a halving of the creatinine clearance to less than 20 ml/min over a period of less than 2 weeks • Very poor prognosis |
• Slowly progressive • Prognosis poor, but patients may live for longer |
Management options
- vasopressin analogues, for example terlipressin, have a growing evidence base supporting their
use.
They work by causing vasoconstriction of the splanchnic circulation
- volume expansion with 20% albumin
- transjugular intrahepatic portosystemic shunt
