LOW-DOSE ORNIPRESSIN IMPROVES RENAL-FUNCTION IN THE HEPATORENAL-SYNDROME

The hepatorenal syndrome may be defined as renal failure that occurs in patients with liver disease in the absence of clinical, laboratory, or anatomical evidence of other known causes (1). Renal failure is considered to be mediated by intense renal vasoconstriction that leads to renal hypoperfusion with preferential renal cortical ischemia (1, 2). Although the renal failure is potentially reversible, the course of the hepatorenal syndrome is most often fatal in the absence of liver transplantation. However, temporary improvement in renal function has been achieved using either metaraminol (3) or the vasopressin analog, octapressin (4). More recently, ornipressin (8-ornithine vasopressin) has been used in patients with functional renal failure and decompensated liver cirrhosis and has been reported to reverse, at least partially, the functional renal impairment as well as the hyperdynamic circulatory state usually observed in this syndrome (5-7). However, except in one patient (5), ornipressin was only applied over a 4-hr period. We report a case of severe hepatorenal syndrome in which ornipressin, administered for several days at a very low dose (1 U/hr), resulted in sustained beneficial effects on renal function and hemodynamics. If these favorable effects are confirmed, ornipressin therapy could be considered as a possible bridge therapy to liver transplantation.