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Pediatric Hepatorenal Syndrome Medication

  • Author: Rajendra Bhimma, MB, MD, ChB, PhD, DCH (SA), FCP(Paeds)(SA), MMed(Natal); Chief Editor: Timothy E Corden, MD  more...
 
Updated: Mar 19, 2015
 

Medication Summary

Vasoconstrictor agents, such as vasopressin analogs (eg, ornipressin, terlipressin) or alpha1-adrenergic agonists (eg, norepinephrine, midodrine) have been used in combination or alone to reverse the peripheral arterial vasodilatation and renal vasoconstriction that is impairing renal function. However, none of these drugs sustain improvement in renal function or reverse hepatorenal syndrome (HRS) without liver transplantation. See Medical Care for more details regarding these medications.

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Vasoconstrictive agents

Class Summary

These agents induce vasoconstriction of the splanchnic vascular bed, which improves systemic and renal perfusion.

Terlipressin (Glypressin)

 

Vasopressin analog. Induces vasoconstriction of the splanchnic vascular bed, improving systemic and renal perfusion with action on V1 vasopressin vascular smooth-muscle-cell receptor. Only pharmacologic agent that reduces mortality related to variceal bleeding.

Widely used in Europe. In the United States, has orphan drug status to treat bleeding esophageal varices.

Biologic activity (2-10 h) longer than that of vasopressin. Has lower incidence of adverse ischemic effects compared to other vasopressin agents.

Ornipressin (POR-8)

 

Not available in United States. Synthetic vasopressin analog with a short half-life. Requires continuous IV administration. V1 vasopressin receptors abundantly expressed in mesenteric arteries compared with other vascular territories. Has been used with albumin to treat HRS but associated with ischemic complications.

Norepinephrine (Levophed)

 

Induces vasoconstriction of the splanchnic vascular bed, improving systemic and renal perfusion with alpha1-adrenergic agonist actions.

Midodrine (ProAmatine)

 

Selective alpha1-adrenoreceptor agonist by causing arterioconstriction and venoconstriction.

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Contributor Information and Disclosures
Author

Rajendra Bhimma, MB, MD, ChB, PhD, DCH (SA), FCP(Paeds)(SA), MMed(Natal) Associate Professor of Pediatrics, Principal Specialist, Department of Pediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa

Rajendra Bhimma, MB, MD, ChB, PhD, DCH (SA), FCP(Paeds)(SA), MMed(Natal) is a member of the following medical societies: American Association for the Advancement of Science, International Society of Nephrology, South African Medical Association, South African Paediatric Association, South African Transplant Society, International Pediatric Transplant Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Barry J Evans, MD Assistant Professor of Pediatrics, Temple University Medical School; Director of Pediatric Critical Care and Pulmonology, Associate Chair for Pediatric Education, Temple University Children's Medical Center

Barry J Evans, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, Wisconsin Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

G Patricia Cantwell, MD, FCCM Professor of Clinical Pediatrics, Chief, Division of Pediatric Critical Care Medicine, University of Miami Leonard M Miller School of Medicine/ Holtz Children's Hospital, Jackson Memorial Medical Center; Medical Director, Palliative Care Team, Holtz Children's Hospital; Medical Manager, FEMA, South Florida Urban Search and Rescue, Task Force 2

G Patricia Cantwell, MD, FCCM is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Heart Association, American Trauma Society, National Association of EMS Physicians, Society of Critical Care Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

The author would like to thank Mr. Duran Ramsuran and the staff of Medscape Drugs & Diseases for the help in reviewing this article.

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Basic transjugular intrahepatic portosystemic shunt (TIPS) procedure. A curved catheter is placed into the right hepatic vein.
 
 
 
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