Hepatorenal syndrome is a functional renal impairment occuring mainly, but not exclusively, in decompensated cirrhosis. Its pronosis is very poor. We studied to evaluate the effect of misoprostol(prostaglandin E1 analogue) in patients with
hepatorenal
syndrome. We observed the therapeutic effect of oral misoprostol (0.4mg, four times per day) for 12 days in six patients with hepatorenal syndrome who had oliguria and renal functional deteriortion despite adequate supplement of fluid.
The mean urinary output obtained over the 4 days preceding misoprostol administration was 263, 328, 275, 232 and 356 ml per 24 hours, respectively, in the six patients, despite adequate volume expansion by plasma albumin and fresh frozen plasma.
Diuresis increased to 906, 900, 625, 1085 and 1038 ml pr 24hours, respectively, on day 1-12 after onset of therapy. In addition of diuresis, serum creatinine levels were 3.5, 2.6, 2.7, 4.5, 4.2 and 3.6mg/dl of renal function in five patients were
evident. Spot urine sodium concentration increased from average 30mEq/L to 40mEq/L in six cases before and during the treatment of misoprostol.
In the present study, the oral administration of high dose of misoprostol in patients with hepatorenal syndrome seems to produce marked diuresis with recovery of renal failure, suggesting again the role of prostaglandin in the pathogenesis of
hepatorenal syndrome. Therefore, until further improvements in the management of hepatorenal syndrome in the future, administration of synthetic prostaglandin E1(misoprodstol) may constitute an acceptable therapeutic intervention.(Korean J
Gastroenterol
1994 ;26 : 498-505)
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