I Hate Hepatorenal Syndrome

This condition occurs in people with cirrhosis who are infected, or dehydrated, or sometimes it just happens for no good reason. It is characterized by slowly or rapidly progressive kidney failure and -- almost inevitably -- death. I rarely take care of people with hepatorenal syndrome, since I don't practice in a liver transplant center. Every single person I've seen with hepatorenal syndrome has died -- except one, who I treated with a combination of midodrine and octreotide (1,2). After a month, she fully recovered. (She isn't a transplant candidate due to a history of recently treated cancer.) The reason I'm depressed, and the reason for this post, is that she was readmitted, and she has hepatorenal syndrome again. This time, I hope she survives.

1. Reversal of type 1 hepatorenal syndrome with the administration of midodrine and octreotide. Hepatology 1999 Jun;29(6):1690-7.
2. Octreotide/midodrine therapy significantly improves survival in Type I hepatorenal syndrome: analysis of 53 treated patients and 21 controls (abstract). Gastroenterology 2003;124:A718.

Addendum (4/25/5): I hate hepatorenal syndrome.