Hepatorenal Syndrome with Cirrhotic Cardiomyopathy: Case Report and Literature Review

Abstract

The hepatorenal syndrome (HRS) is defined as a potentially reversible kidney failure in patients with cirrhosis and ascites. An association of HRS and cirrhotic cardiomyopathy has been reported recently, but there are no result studies about the use of positive inotropes as part of the acute phase treatment. We report the case of a patient diagnosed with HRS, with high levels of NT pro-BNP, but with normal ejection fraction of the left ventricle, which showed abnormalities in systolic function through speckle tracking in echocardiography, reversible after the infusion of dobutamine. The patient showed clinical and laboratory improvement of his renal function after the infusion of dobutamine. Clinical studies are needed on HRS therapeutic approach taking into account the myocardial dysfunction as a major contributing factor to renal dysfunction.

Cirrhotic Cardiomyopathy: Another Case of a Successful Approach to Treatment of Hepatorenal Syndrome

“…Treatment with dobutamine has already been described in a similar case report, but with other etiology of liver cirrhosis [23]. The cited case described a white male patient with alcoholic cirrhosis infected with hepatitis C virus.…”

“…The cited case described a white male patient with alcoholic cirrhosis infected with hepatitis C virus. Because that patient was also refractory to standard therapy for HRS, dobutamine infusion was helpful reverting renal impairment [23]. In this case, the patient had advanced cryptogenic cirrhosis, with higher Child and MELD scores.…”

Hepatorenal syndrome

“…With this in mind, further studies are recommended in assessing the role of inotropes in patients with HRS as myocardial dysfunction is a key factor in HRS. 29 Cytokine-mediated vasodilation nitric oxide Splanchnic dilation occurs as a result of increased production of several vasodilators including nitric oxide (NO). NO is produced in cirrhosis as a result of up-regulation of endothelial NO synthase activity from increased shear stress on splanchnic and systemic circulation.…”

Brain Natriuretic Peptide in Cirrhosis

“…According to that we can expect in some stages of disease elevation of BNP. Progression of the disease leads to many hemodynamic changes and consequently diastolic heart failure, with high left atrial pressure, lower cardiac output and higher peripheral vascular resistance [16][17][18].…”