title: Renal failure in cirrhotic patients: role of terlipressin in clinical approach to hepatorenal syndrome type 2.
abstract: 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.
authors.affiliation: Department of Gastroenterology, San Giovanni Battista Hospital, Torino, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Alessandria
authors.forename: Wilma Debernardi
authors.initials: WD
authors.lastname: Venon
authors.forename: Alfredo
authors.initials: A
authors.lastname: Marzano
authors.forename: Claudio
authors.initials: C
authors.lastname: Barletti
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fadda
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzetto
mesh_terms: 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*
chemical_list: D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin