Hepatorenal syndrome

Hepatorenal syndrome (HRS) is the development of renal failure in patients with advanced chronic liver disease and, occasionally, fulminant hepatitis, who have portal hypertension and ascites.

Pharmacological treatment

Vasoconstrictor therapy

Vasoconstrictor	Route	Recommended dosage
Terlipressin	Bolus	Initially 0.5 mg (IV) 4–6 hourly. If no response by day 3 can increase the dosage to 1 mg 4–6 hourly. Maximum dosage is 2 mg 4–6 hourly. Maximum duration 14 days.
Terlipressin	Continuous infusion	Initially 2 mg/day. If no response by day 3, can increase the dosage to 4 mg/day. Maximum dosage is 12 mg/day. Maximum duration 14 days.
Norepinephrine	Continuous infusion	0.5–3 mg/hour continuously to achieve an increase in mean arterial pressure of 10 mmHg. Treatment is to be continued until serum creatinine concentration is <1.5 mg/dL or <133 µmol/L.

Albumin therapy

Albumin must be given concomitantly with any of the vasoconstrictors at a dosage of 20–40 g/day.

Imeandikwa:

Jumanne, 23 Juni 2026, 6:21:54 GMT +3

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