Terlipressin and gelafundin: safe therapy of hepatorenal syndrome.
OBJECTIVE
Hepatorenal syndrome (HRS) occurs in about 20 % of patients with liver cirrhosis and ascites and is characterized by intensive renal vasoconstriction, low glomerular filtration rate but preserved tubular function and normal renal histology. The potential of terlipressin and albumin to reverse HRS after a time period of 14 days has already been shown. However, intravenous albumin is expensive (approximately 25 per 50 ml 20% albumin in Germany) and has limited availability in some settings. Therefore we used an artificial plasma substitute, Gelatinepolysuccinat, which is less expensive (approximately 12 per 500 ml). The aim of our present study was to examine the effects of terlipressin and Gelatinepolysuccinat on renal function and hemodynamics in a time period of six days.


METHODS
Seven consecutive patients with cirrhosis and hepatorenal syndrome were included in a pilot study of terlipressin (6 mg /24 h iv) therapy associated with i.v. Gelatinepolysuccinat (Gelafundin 4% Infusionslösung, Company Braun, Mw: 30 000 D).


RESULTS
In five of the seven patients treatment was associated with a marked reduction of serum creatinine after six days (3.85 +/- 0.44 mg/dl vs.1.9 +/- 0.32 mg/dl; p< 0.018). Creatinine clearance improved (20 +/- 8.8 ml/min vs. 43 +/- 11.7 ml/min; p<0.12). There was a remarkable improvement in circulatory function in all patients, with an increase in mean arterial pressure (58+/-4.4 mmHg vs. 75 +/- 4.5 mmHg, p< 0.001). No patient developed signs of intestinal, myocardial or distal ischemia.


CONCLUSIONS
Terlipressin and Gelatinepolysuccinat appear to be a safe and effective treatment of hepatorenal syndrome.
Saner
F
F
Department of General Surgery and Transplantation, University of Essen, Essen, Germany. fuat.saner@uni-essen.de
Kavuk
I
I
Lang
H
H
Biglarnia
R
R
Frühauf
N R
NR
Schäfers
R F
RF
Malagó
M
M
Broelsch
C E
CE
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D005780:Gelatin / Q000008:administration & dosage / Q000627:therapeutic use*; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006530:Hepatorenal Syndrome / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007275:Injections, Intravenous; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D007677:Kidney Function Tests; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D010865:Pilot Projects; D010952:Plasma Substitutes / Q000008:administration & dosage / Q000627:therapeutic use*; D000077585:Terlipressin; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D010952:Plasma Substitutes; D008236:Lypressin; D000077585:Terlipressin; D005780:Gelatin; D003404:Creatinine