Current position of vasoconstrictor and albumin infusion for type 1 hepatorenal syndrome

Core Tip

Core tip: Type 1 hepatorenal syndrome (HRS), which presents as acute kidney injury, is an uncommon, but critical problem in decompensated cirrhosis. The most common precipitating factor is infection especially spontaneous bacterial peritonitis. The combined regimen of albumin and vasoconstrictor is the pharmacotherapy of choice for type 1 HRS based on pathogenic mechanisms of peripheral and splanchnic vasodilatation. Prompt treatment with the combined regimen can lead to HRS reversal in 34%-60% of patients. Type 1 HRS can be prevented in cirrhotic complications such as albumin infusion for spontaneous bacterial peritonitis, large volume paracentesis with albumin replacement, and prophylactic antibiotics for upper gastrointestinal hemorrhage.