Table 5.

Prevention of hepatorenal syndrome and general patient management strategies

Avoid drugs that reduce renal perfusion or nephrotoxic substances

Minimize exposure to organ-iodated contrast agents

Intravenous albumin is recommended for volemic filling after large volume paracentesis (8 g of albumin for each liter of ascites removed)

Diuretic therapy should be suspended

Pentoxifylline as drug’s anti-TNFa activity

Antibiotic prophylaxis to prevent infections reducing intestinal bacterial translocation (norfloxacin 400 mg/d)

Intravenous albumin administered in association with ceftriaxone in SPB

Adrenal insufficiency should be identified and treated

Drug dosages must be adjusted according to renal function