Hepatorenal Syndrome with Cirrhotic Cardiomyopathy: A Case Series of A New Approach for Re-fractory Patients

Abstract

Cirrhosis is a common disease that may be complicated with multiple organ dysfunctions, including a progressive deterioration of cardiac and renal function. Hepatorenal syndrome (HRS) is defined as potentially reversible renal failure in patients with liver cirrhosis and ascites. Cirrhotic cardiomyopathy (CCM) is a chronic cardiac dysfunction in cirrhosis in the absence of known cardiac disease. An association between CCM and HRS is suggested in cases of advanced cirrhosis that are nonresponsive to the usual therapies for HRS. We report four cases of patients with severe liver cirrhosis in different evolutionary stages of CCM who were diagnosed with HRS type I refractory to usual protocols. In these scenarios, a positive inotropic drug was temporarily used in an attempt to reverse the worsening of renal function. This case series may suggest a treatment with efficacy for refractory HRS, although randomized controlled studies are needed to confirm this hypothesis.