Hepatorenal Syndrome Is Reversible with Medical Therapy Plus TIPS

Hepatorenal syndrome (HRS) is a functional renal disorder. Development of HRS in patients who have cirrhosis and ascites is associated with median survival of 1.7 weeks. Despite progressive renal failure, kidneys are normal, and the syndrome is thought to be potentially reversible. In a small study (Hepatology 1999; 29:1690), a combination of octreotide, albumin, and midodrine (an alpha agonist that improves systemic blood pressure and renal perfusion) led to significant improvement in renal function in HRS patients, but did not completely reverse the abnormality. Similarly, use of a transjugular intrahepatic portosystemic shunt (TIPS) has been shown to reduce serum creatinine levels and improve renal sodium secretion in 60% of HRS patients…