What is the role for terlipressin in hepatorenal syndrome?

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What is the role for terlipressin in hepatorenal syndrome? Q: With careful patient selection, terlipressin, a synthetic analogue of vasopressin, is an effective therapy for hepatorenal syndrome (HRS). The drug has compared favorably with placebo and, based on limited data, other vasoconstrictors. ■ HEPATORENAL SYNDROME: UPDATED DEFINITIONS HRS is a serious complication of advanced liver disease defi ned by kidney dysfunction associated with complex changes in the splanchnic circulation resulting in vasoconstriction and renal hypoperfusion. 1 Traditionally, acute HRS, characterized by a rapid decline in kidney function, has been referred to as type 1 HRS; chronic HRS, characterized by progressively worsening kidney function, has been referred to as type 2 HRS. 2 The diagnostic criteria for HRS were revised recently based on the International Club of Ascites defi nition of acute kidney injury (AKI) in patients with cirrhosis (Table 1). 1 The updated defi nition addresses the potential overestimation of renal function based on the serum creatinine (SCr) level in patients with cirrhosis, where SCr is reduced because of malnutrition and muscle wasting. 2 The revised definition reclassifi es type 1 HRS as HRS-AKI and type 2 HRS as HRS-chronic kidney disease. 2 HRS-AKI is considered a diagnosis of exclusion. The ultimate therapy for HRS-AKI may be liver transplant in appropriate candidates. However, because AKI is associated with signifi cantly increased mortality risk, 3 therapies are needed that target reversal of HRS-AKI and potentially serve as a bridge to liver transplant. Unfortunately, there are limited treatment options for HRS-AKI. Current therapies include the combination of midodrine and octreotide, norepinephrine, and terlipressin.

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