A Case of Type I Hepatorenal Syndrome Treated with Vasopressin

Laura Connor, Geoffrey Teehan

Department of Internal Medicine, Lankenau Medical Center, Wynnewood, USA.
Department of Nephrology, Lankenau Medical Center, Wynnewood, USA.

DOI: 10.4236/ojneph.2013.33025                

Abstract

Hepatorenal syndrome (HRS) is a grave complication of end-stage liver disease and is associated with a very high mortality. This case report described a 42-year-old female with advanced alcohol-induced cirrhosis who developed HRS that was initially treated with Midodrine and Octreotide but renal function continued to deteriorate. Vasopressin therapy was added and HRS was successfully reversed. There are few data available on the use of vasopressin for HRS and this case supports its use in treatment of HRS, particularly in countries where the more widely studied Terlipressin is unavailable. This case also demonstrates that a patient failing one medical therapy for HRS may respond to an alternative or adjunctive therapy. Therefore, this should be attempted to increase the patient’s chance of survival.

Keywords

Hepatorenal Syndrome; Vasopressin

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	C. Alessandria, A. Ottobrelli, W. Debernardi-Venon, L. Todros, M. T. Cerenzia, S. Martini, et al., “Noradrenalin vs Terlipressin in Patients with Hepatorenal Syndrome: A Prospective, Randomized, Unblinded, Pilot Study,” Journal of Hepatology, Vol. 47, No. 4, 2007, pp. 499-505. doi:10.1016/j.jhep.2007.04.010
[2]	S. J. Munozo, “The Hepatorenal Syndrome,” Medical Clinics of North America, Vol. 92, No. 4, 2008, pp. 813-837. doi:10.1016/j.mcna.2008.03.007
[3]	T. H. Kiser, R. Maclaren and D. N. Fish, “Treatment of Hepatorenal Syndrome,” Pharmacotherapy, Vol. 29, No. 10, 2009, pp. 1196-1211. doi:10.1592/phco.29.10.1196
[4]	P. Angeli, R. Volpin, G. Gerunda, R. Craighero, P. Roner, R. Merenda, et al., “Reversal of Type 1 Hepatorenal Syndrome with the Administration of Midodrine and Octreotide,” Hepatology, Vol. 29, No. 6, 1999, pp. 1690-1697. doi:10.1002/hep.510290629
[5]	E. Esrailian, E. R. Pantangco, N. L Kyulo, K. Q. Hu and B. A. Runyon, “Octreotide/Midodrine Therapy Significantly Improves Renal Function and 30-Day Survival in Patients with Type 1 Hepatorenal Syndrome,” Digestive Diseases and Sciences, Vol. 52, No. 3, 2007, pp. 742-748. doi:10.1007/s10620-006-9312-0
[6]	G. Pomier-Layragues, S. C. Paquin, Z. Hassoun, M. Lafortune and A. Tran, “Octreotide in Hepatorenal Syndrome: A Ransomized Double-Blind, Placebo-Controlled, Corssover Study,” Hepatology, Vol. 38, No. 1, 2003, pp. 238-243. doi:10.1053/jhep.2003.50276
[7]	R. Moreau, F. Durand, T. Poynard, C. Duhamel, J. P. Cervoni, P. Ichai, et al., “Terlipressin in Patients with Cirrhosis and Type 1 Hepatorenal Syndrome: A Retroepsctive Mulitcenter Study,” Gastroenterology, Vol. 122, No. 4, 2002, pp. 923-930. doi:10.1053/gast.2002.32364
[8]	C. Halimi, P. Bonnard, D. Bernard, P. Mathurin, A. Mofredj, V. Martino, et al., “Effect of Terlipressin (Glypressin) on Hepatorenal Syndrome in Cirrhotic Patients: Results of a Multicentre Pilot Study,” European Journal of Gastroenterology & Hepatology, Vol. 14, No. 2, 2002, pp. 153-158. doi:10.1097/00042737-200202000-00009
[9]	A. J. Sanyal, T. Boyer, G. Garcia-Tsao, F. Regenstein, L. Rossaro, B. Appenrodt, et al., “A Randomized, Prospective, Double-Blind, Placebo-Controlled, Trial of Terlipressin for Type 1 Hepatorenal Syndrome,” Gastroenterology, Vol. 143, No. 5, 2008, pp. 1360-1368. doi:10.1053/j.gastro.2008.02.014
[10]	P. Solanki, A. Chawla, R. Garg, R. Gupta, M. Jain and S. K. Sarin, “Beneficial Effects of Terlipressin in Hepatorenal Syndrome: A Prospective, Randomized PlaceboControlled Clinical Trial,” Journal of Gastroenterology Hepatology, Vol. 18, No. 2, 2003, pp. 152-156. doi:10.1046/j.1440-1746.2003.02934.x
[11]	Y. Narahara, H. Kanazawa, C. Sakamoto, H. Maruyama, O. Yokosuka, S. Mochida, et al., “The Efficacy and Safety of Terlipressin and Albumin in Patients with Type 1 Hepatorenal Syndrome: A Multicenter, Open-Label, Explorative Study,” Journal of Gastroenterology, Vol. 47, No. 3, 2011, pp. 313-320. doi:10.1007/s00535-011-0485-8
[12]	A. G. Testro, S. Wongseelashote, P. W. Angus and P. J. Gow, “Long-Term Outcome of Patients Treated with Terlipressin for Types 1 and 2 Hepatorenal Syndrome,” Journal of Gastroenterology and Hepatology, Vol. 23, No. 10, 2008, pp. 1535-1540. doi:10.1111/j.1440-1746.2007.05176.x
[13]	S. Neri, D. Pulvirenti, M. Malaguarnera, B. M. Cosimo, G. Bertino, L. Ignaccolo, et al., “Terlipressin and Albumin in Patients with Cirrhosis and Type I Hepatorenal Syndrome,” Digestive Diseases and Sciences, Vol. 53, No. 3, 2008, pp. 830-835. doi:10.1007/s10620-007-9919-9
[14]	M. Martin-Llahi, M. N. Pepin, M. Guevara, F. Diaz, A. Torre, A. Monescillo, et al., “Terlipressin and Albumine vs. Albumin in Patients with Cirrhosis and Hepatorenal Syndrome: A Randomized Study,” Gastroenterology, Vol. 134, No. 5, 2008, pp. 1353-1359. doi:10.1053/j.gastro.2008.02.024
[15]	R. Ortega, P. Gines, J. Uriz, A. Cardenas, B. Calahorra, D. De Las Heras, et al., “Terlipressin Therapy with and without Albumin for Patients with Hepatorenal Syndrome: Results of a Prospective, Nonrandomized Study,” Hepatology, Vol. 36, No. 4, 2002, pp. 941-941. doi:10.1053/jhep.2002.35819
[16]	M. Guevera, P. Gines, G. Fernandez-Esparrach, P. Sort, J. M. Salmero, W. Jimenez, et al., “Reversibility of Hepatorenal Syndrome by Prolonged Administration of Ornipressin and Plasma Volume Expansion,” Hepatology, Vol. 27, No. 1, 1998, pp. 35-41. doi:10.1002/hep.510270107
[17]	V. Gulberg, M. Blizer and A. L. Gerbes, “Long-Term Therapy and Retreatment of Hepatorenal Syndrome Type 1 with Ornipressin and Dopamine,” Hepatology, Vol. 30, No. 4, 1999, pp. 870-875. doi:10.1002/hep.510300430
[18]	T. H. Kiser, D. N. Fish, M. D. Obritsch, R. Jung, R. MacLaren and C. R. Rarikh, “Vasopressin, Not Octreotide, May Be Beneficial in the Treatment of Hepatorenal Syndrome: A Retrospective Study,” Nephrology Dialysis Transplantation, Vol. 20, No. 9, 2005, pp.1813-1820. doi:10.1093/ndt/gfh930