Journal Reading:

Medical Management of Hepatorenal

Syndrome

Oleh:
T. Tomy Saputra, S.Ked
I11108030
Pembimbing:
dr. Hadi Juanda, Sp.PD
Kepaniteraan Klinik Ilmu Penyakit Dalam
RST. Kartika Husada FK UNTAN
Pontianak
2015

Introduction (1)
Hepatorenal syndrome (HRS) is
defined as the occurrence of
renal dysfunction (functional
renal failure) in a patient with
end-stage liver cirrhosis in the
absence of another identifiable
cause of renal failure (renal
pathology)
Type 1 HRS & Type 2 HRS

Introduction (1)
Type 1 HRS is characterized by a
progressive impairment in renal
function and a significant reduction in
creatinine clearance within 12 weeks
of presentation.
Type 2 HRS is characterized by a
reduction in glomerular filtration rate
with an elevation of serum creatinine
level, but it is fairly stable and is
associated with a better outcome than
that of Type 1 HRS.

Patogenesis

Sirosis Hepatis + Hipertensi

porta vasodilatasi arteri
splanknik hipovolemi arterial
sentral aktivasi (simpatis,
RAA, ADH) vaso-konstriksi
renal perubahan intrarenal (
vasokonstriktor; vasodilator )
vasokonstriksi renal )
sindrom hepatorenal

Results
Prevention of HRS
Assesement of intravascular
volume in patients with cirrhosis
Fluid resuscitation in HRS
Paracentesis
Pharmacological treatment of
HRS

Prevention of HRS
Type 1 HRS patients should be
closely monitored and precipitating
factors including bacterial infection
should be actively sought and
treated (not graded).
Drugs reducing renal perfusion or
directly causing nephrotoxicity
should be avoided when possible
Exposure to contrast should be
minimized

Assesement of intravascular
volume in patients with
cirrhosis

Excessive administration of fluids

should be avoided to prevent
volume overload

Fluid resuscitation in HRS

Patients with HRS should be

optimally resuscitated, with
intravenous administration of
albumin (initially 1 g of
albumin/kg of body weight, up to
a maximum of 100 g, followed by
2040 g/day) in combination with
vasopressor therapy (1A), for up
to 14 days

Paracentesis

In cirrhotics, paracentesis is
typically performed for
symptomatic relief

Pharmacological
treatment of HRS
Vasoconstrictors: vasopressin,
terlipressin, norepinephrine
(noradrenaline), octreotide and
midodrine, Other agents
(Ornipressin)
Albumin + terlipressin (vasopressin/
norepinephrine/octreotide and
midodrine/Ornipressin) up to 14
days

Conclusions
Although the introduction of
terlipressin and albumin has improved
the outlook for patients with HRS, only
~50% of patients respond to therapy
In addition, the effects of changes in
IAP on renal function in patients with
HRS have not been explored and may
need to be considered in terms of
renal perfusion pressure, along with
MAP

Terima Kasih