Hepatorenal syndrome: Difference between revisions
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==Pathophysiology== | ==Pathophysiology== | ||
Functional renal vasoconstriction leading to severe redxn in GFR with minimal renal histologic abnormalities | Functional renal vasoconstriction leading to severe redxn in GFR with minimal renal histologic abnormalities | ||
==Diagnosis== | ==Diagnosis== | ||
#Type 1: doubling of serum Cr to > 2.5mg/dl in < 2wk | |||
#Type 2: stable or less rapidly progressive course than Type 1 | |||
Type 1: doubling of serum Cr to > 2.5mg/dl in < 2wk | #Type 1 & 2 both require^: | ||
##Cr >1.5mg/dl | |||
Type 2: stable or less rapidly progressive course than Type 1 | ##Cr NOT reduced below 1.5mg/dl with administration of albumin (1g/kg) and after a minimum of 2 days off diuretics | ||
##Abscence of current or recent rx with potentially nephrotoxic drugs | |||
Type 1 & 2 both require | ##Abscence of shock | ||
##Abscence of renal parenchymal disease (urinary excretion of >500mg protein/d, >50 RBC/hpf, abnl kidneys on U/S) | |||
==DDx== | ==DDx== | ||
#Hypovolemia-induced renal failure (GI bleed or fluid losses 2/2 diuretics, diarrhea most common) | |||
#Parenchymal renal disease (proteinuria >500mg protein/d, >50 RBC/hpf or both; confirmed with renal biopsy) | |||
#Drug-induced renal failure (current NSAIDs, aminoglycosides) | |||
==Treatment== | ==Treatment== | ||
#Vasoconstrictors | |||
##Terlipressin: 0.5-1mg q 4-6 IV us 5-15d | |||
Vasoconstrictors | ##Norepi: 0.5-3mg/hr to increase MAP by 10mmHg | ||
##Midrodrine: 7.5mg PO tid with Octreotide 100mcg sq | |||
#Albumin: 1-1.5g/kg with one of above | |||
#Other: TIPS, renal replacement therapy | |||
Albumin: 1-1.5g/kg with one of above | |||
Other: TIPS, renal replacement therapy | |||
==Disposition== | ==Disposition== | ||
#1-month survival: 50% | |||
#6-month survival: 20% | |||
1-month survival: 50% | |||
6-month survival: 20% | |||
==Source== | ==Source== | ||
Adapted from NEJM vol 361 no 13 P. Gines | Adapted from NEJM vol 361 no 13 P. Gines | ||
^International Ascites Club criteria | |||
[[Category:GI]] | [[Category:GI]] | ||
Revision as of 11:59, 14 March 2011
Pathophysiology
Functional renal vasoconstriction leading to severe redxn in GFR with minimal renal histologic abnormalities
Diagnosis
- Type 1: doubling of serum Cr to > 2.5mg/dl in < 2wk
- Type 2: stable or less rapidly progressive course than Type 1
- Type 1 & 2 both require^:
- Cr >1.5mg/dl
- Cr NOT reduced below 1.5mg/dl with administration of albumin (1g/kg) and after a minimum of 2 days off diuretics
- Abscence of current or recent rx with potentially nephrotoxic drugs
- Abscence of shock
- Abscence of renal parenchymal disease (urinary excretion of >500mg protein/d, >50 RBC/hpf, abnl kidneys on U/S)
DDx
- Hypovolemia-induced renal failure (GI bleed or fluid losses 2/2 diuretics, diarrhea most common)
- Parenchymal renal disease (proteinuria >500mg protein/d, >50 RBC/hpf or both; confirmed with renal biopsy)
- Drug-induced renal failure (current NSAIDs, aminoglycosides)
Treatment
- Vasoconstrictors
- Terlipressin: 0.5-1mg q 4-6 IV us 5-15d
- Norepi: 0.5-3mg/hr to increase MAP by 10mmHg
- Midrodrine: 7.5mg PO tid with Octreotide 100mcg sq
- Albumin: 1-1.5g/kg with one of above
- Other: TIPS, renal replacement therapy
Disposition
- 1-month survival: 50%
- 6-month survival: 20%
Source
Adapted from NEJM vol 361 no 13 P. Gines
^International Ascites Club criteria