Renal failure in cirrhotic patients: role of terlipressin in clinical approach to hepatorenal syndrome type 2.
OBJECTIVE
Renal failure secondary to hepatorenal syndrome or to organic renal disease occurs frequently in cirrhotic patients with portal hypertension. The present prospective study investigates the usefulness of terlipressin in both the diagnostic and the therapeutic approach to cirrhotics with renal failure.


METHODS
Sixteen patients were studied: 11 with hepatorenal syndrome type 2 (group 1) and five with organic renal disease (group 2). All received terlipressin (1 mg/4 h intravenously) for 7 days. Subsequently, 12 patients (nine from group 1 and three from group 2) underwent a transjugular intrahepatic portosystemic shunt.


RESULTS
Terlipressin significantly improved renal function (serum creatinine, 1.8 +/- 0.8 versus 2.4 +/- 0.9 mg/dl; blood creatinine clearance, 53 +/- 8 versus 21.3 +/- 8.7 ml/min; P < 0.05) in group 1 [8/11 patients (73%) versus 1/5 (20%) of group 2; P < 0.05]. The only patient in group 2 who responded to terlipressin had a mixed renal dysfunction. Renal function improved significantly after transjugular portosystemic shunt in all patients who responded to terlipressin.


CONCLUSIONS
Terlipressin administration significantly improves renal function in cirrhotic patients with hepatorenal syndrome type 2 but not in organic kidney failure. By providing the critical information that a patient's kidney function is (or is not) reversible, a trial with terlipressin may be useful when selecting cirrhotic patients with renal failure as candidates for a transjugular intrahepatic portosystemic shunt or liver transplantation.
Alessandria
Carlo
C
Department of Gastroenterology, San Giovanni Battista Hospital, Torino, Italy.
Venon
Wilma Debernardi
WD
Marzano
Alfredo
A
Barletti
Claudio
C
Fadda
Maurizio
M
Rizzetto
Mario
M
D005260:Female; D006530:Hepatorenal Syndrome / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical; D011446:Prospective Studies; D000077585:Terlipressin; D016896:Treatment Outcome; D014554:Urination / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin