PROSTAGLANDIN ANALOGUES AND REVERSAL OF HEPATORENAL SYNDROME: FACT OR FICTION?

Oral misoprostol was given to four patients with hepa‐torenal syndrome. All patients had alcoholic cirrhosis. Two were male and two were female. The average age was 52 yr, ranging from 30 to 67 yr. All had moderate to tense ascites and esophageal varices. In addition, all patients had encephalopathy, jaundice, and an elevated prothrombin time. All four patients received misoprostol in a dose of 0.4 mg four times daily, as well as plasma expanders of albumin and fresh frozen plasma. Based on urinary output over a 3‐day period prior to therapy, mean urinary outputs of the four patients were 250, 315, 550, and 195 ml/24 h, respectively. After 2–4 days of therapy with misoprostol, urinary volumes increased to 1450, 2440, 925, and 1300 ml/24 h, re‐spectively. Serum creatinine levels fell in all patients after 4 days of therapy. Urinary sodium excretion re‐portedly improved in all eases. Urinary creatinine excretion was also said to improve. Three of the four patients died within 40 days of treatment. This was due to causes other than renal failure. The fourth patient underwent a liver transplant.