The Effect of Terlipressin in the Prevention of Type 2 Hepatorenal Syndrome by Improving Mean Arterial Pressure

Inclusion Criteria: 1. cirrhosis as diagnosedby liver biopsy or clinical, biochemical, ultrasound,and/or endoscopic findings; 2. type 2 HRS with a MAP decrees for at least 10mmHg compared to basal blood pressure ; 3. age 18 to65 years; 4. absence of severe bacterial infection associated with findings of systemic inflammatory response as diagnosedby the presence of at least 2 of the following criteria: body temperature \<36°C or \>38°C, heart rate \>90 beats/min, respiration rate\>20/min, and white-cell count \<4 or \>12 X106/L or \>6% of band forms; patients with bacterial infections, however, could be included in the study if renal failure persisted after infection resolution; 5. the absence of cardiovascular diseases and any extra hepatic disease that could affect the short-term prognosis; 6. the absence of findings suggestive of organic nephropathy; 7. the absence of advanced hepatocellularcarcinoma. Exclusion Criteria: 1. Patients with history of coronary artery disease 2. Cardiomyopathy 3. Ventricular arrhythmia 4. Obstructive arterial disease of limbs -