Hepatorenal Syndrome

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Hepatorenal syndrome (HRS) is the development of renal failure in patients with advanced chronic  liver disease and, occasionally, fulminant hepatitis, who have portal hypertension and ascites. 

Table 10.3: Pharmacological treatment 

Vasoconstrictor		Recommended Dosage
S: terlipressin   OR	Bolus	Initially 0.5 mg (IV) 4-6hourly. If no response by day 3 can increase the dosage to 1mg 4-6hourly. Maximum dosage is 2mg 4-6hourly. Maximum duration 14days.
	Continuous Infusion	Initially 2mg/day. If no response by Day 3, can increase the dosage to 4mg/day. Maximum dosage is 12mg/day. Maximum duration 14days.
S: norepinephrine	Continuous Infusion	0.5-3mg/hour continuously to achieve an increase in mean arterial pressure of 10 mmHg. Treatment is to be continued until serum creatinine concentration is < 1.5mg/dL, or < 133µmol/L.
S: Albumin must be given concomitantly with any of the vasoconstrictors at a dosage of 20-40 g/day.