felypressin and Liver-Cirrhosis

Renal failure is common in patients who are dying from end-stage cirrhosis, developing in 40-80% of all patients. Where there is no anatomical or pathological cause for the renal failure, it is termed the hepatorenal syndrome. When the hepatorenal syndrome develops, it will only recover when there is some degree of improvement in liver function. Thus for most patients this will occur only after liver transplantation, although the transplantation mortality is increased in this group. Hepatorenal syndrome is a common complication of alcoholic hepatitis, and this group is unusual in that with time and abstinence, significant recovery of liver function may occur. There is therefore a need for supportive therapy to allow time for some recovery of liver function in patients with alcoholic hepatitis and hepatorenal syndrome. Similarly, patients may need support whilst waiting for liver transplantation. This article reviews the pathophysiology and treatment of hepatorenal syndrome.

Topics: Disease Progression; Felypressin; Hepatitis, Alcoholic; Hepatorenal Syndrome; Humans; Liver Cirrhosis; Liver Transplantation; Lypressin; Octreotide; Renal Agents; Terlipressin; Vasoconstrictor Agents

The effect of octapressin (2-phenylalanine-8-lysine vasopressin) on renal and intrarenal blood flow was studied in 11 normotensive cirrhotic patients with abnormal renal perfusion. Renal haemodynamic changes were assessed with the (133)Xenon washout technique. Of the six patients given suppressor doses of octapressin intravenously renal blood flow improved in one only. A further three patients responded to the drug in a dose which increased the mean arterial pressure by 5 or more mm Hg. The increase in mean renal blood flow was accompanied by an improvement in renal cortical perfusion. In two patients renal blood flow decreased after the administration of octapressin. These findings, in conjunction with previous reports, suggest that octapressin will only consistently improve renal perfusion in cirrhotic subjects who are hypotensive and in whom the mean arterial blood pressure is raised by the drug, but do not exclude the possibility that octapressin may have a direct renal circulatory effect in some patients.

Topics: Adult; Alkaline Phosphatase; Bilirubin; Blood Flow Velocity; Blood Pressure; Creatinine; Felypressin; Female; Humans; Hypertension, Portal; Hypotension; Kidney; Kidney Failure, Chronic; Liver Cirrhosis; Male; Middle Aged; Serum Albumin; Vasopressins; Xenon

Topics: Esophageal and Gastric Varices; Felypressin; Female; Fructose; Hemorrhage; Humans; Injections, Intravenous; Liver Cirrhosis; Male; Vasopressins

Topics: Blood Pressure; Blood Pressure Determination; Felypressin; Heart; Hepatic Veins; Humans; Intestines; Liver Circulation; Liver Cirrhosis; Pallor; Pharmacology; Physiology; Splanchnic Circulation; Spleen; Sweating; Toxicology; Vasopressins

Topics: Blood Circulation; Blood Pressure; Felypressin; Heart Function Tests; Hemodynamics; Hepatic Artery; Hepatic Veins; Humans; Hypertension; Hypertension, Portal; Liver Cirrhosis; Pharmacology; Vasopressins