Alcoholic cirrhosis-associated hepatorenal syndrome treated with vasoactive agents.

BACKGROUND

A 35-year-old man with alcoholic cirrhosis, ascites and alcoholic hepatitis presented with new-onset renal insufficiency of unclear etiology after recovery from an episode of gastrointestinal bleeding. Renal function continued to worsen after cessation of diuretic therapy and initiation of volume resuscitation.

INVESTIGATIONS: Physical examination, abdominal ultrasound, liver tests, basic metabolic panel, abdominal paracentesis, renal function tests, 24-h urine collections.

DIAGNOSIS: Type 1 hepatorenal syndrome (HRS).

MANAGEMENT: Intravascular volume resuscitation with normal saline and albumin followed by oral midodrine plus subcutaneous octreotide therapy. This regimen was continued until improvement and subsequent normalization of the serum creatinine.