What does octreotide do in hepatorenal syndrome?
The patient is still alive after 5 months of follow-up, with refractory ascites treated by large-volume paracentesis every 2–4 weeks, and is awaiting a liver transplant. Octreotide is known to induce selective splanchnic vasoconstriction, whereas it has no significant effect on systemic and renal hemody- namics.
What is the treatment for hepatorenal syndrome?
The only curative therapy for individuals with hepatorenal syndrome is a liver transplant, which corrects both the liver disease and associated impaired renal function. Even after successful liver transplantation, patients who had hepatorenal syndrome beforehand may not fully recover their kidney function.
Does octreotide affect renal function?
Octreotide alone does not improve renal function in cirrhotic patients with ascites. On the contrary, adding it to diuretic treatment increases glomerular filtration rate and sodium and water excretion, mainly through the suppression of an activated renin–aldosterone axis.
Why is there Midodrine in hepatorenal syndrome?
The other patient had hepatorenal syndrome (HRS) requiring hemodialysis. In both cases, midodrine was apparently initiated to treat hypotension. In these 2 patients, the addition of midodrine was found to be beneficial, causing a decrease in both the frequency of LVP and the volume of ascitic fluid drained.
How does octreotide work on somatostatin receptors?
Octreotide is an analog of the polypeptide hormone somatostatin. Octreotide acts on the somatostatin receptors, which couple to phospholipase C via inhibitory G proteins, and causes vascular smooth muscle contraction. The alpha and beta-gamma subunits of the G proteins inhibit adenyl cyclase and stimulate phospholipase C, respectively.
When did hepatorenal syndrome become a medical condition?
In the late 19th century, reports by Frerichs (1861) and Flint (1863) noted an association among advanced liver disease, ascites, and oliguric renal failure in the absence of significant renal histologic changes ( 1 ).
What are the two subtypes of hepatorenal syndrome?
Two subtypes of HRS have been identified: Type 1 HRS is a rapidly progressive renal failure that is defined by doubling of initial serum creatinine to a level >2.5 mg/dl or by 50% reduction in creatinine clearance to a level <20 ml/min in <2 wk. Type 2 HRS is a moderate, steady renal failure with a serum creatinine of >1.5 mg/dl.
What are the effects of octreotide and albumin?
Octreotide antagonizes the action of various splanchnic vasodilators and reduces the mismatch between the extent of arterial vasodilatation and the intravascular volume. Albumin increases circulatory volume. Their combined effects improve systemic hemodynamics and consequently improve renal circulation.
