Difference between revisions of "Hepatorenal syndrome"

m (Rossdonaldson1 moved page Hepatorenal Syndrome to Hepatorenal syndrome)
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Revision as of 19:35, 11 May 2015

Background

  • Acute renal failure in pt w/ nl kidneys in presence of acute/chronic hepatic failure
  • Often heralded by the presence of SBP
  • Cause is unknown

Diagnosis

  1. Type 1
    1. Doubling of serum Cr over a 2-week period
    2. Progressive oliguria
  2. Type 2
    1. Gradual impairment in renal function (that may not advance beyond moderate)
  3. Type 1 & 2 both require:
    1. Cr >1.5mg/dl
    2. Cr not reduced below 1.5 w/ albumin (1g/kg) and after minimum of 2 days off diuretics
    3. Abscence of current or recent rx with potentially nephrotoxic drugs
    4. Abscence of shock
    5. Abscence of renal parenchymal disease:

DDx

  1. Hypovolemia-induced renal failure
    1. GI bleed
    2. Diuretics
    3. Diarrhea
  2. Parenchymal renal disease
    1. Urinary excretion of >500mg protein/d, >50 RBC/hpf, abnl kidneys on U/S
  3. Drug-induced renal failure (NSAIDs, aminoglycosides)

Treatment

  1. Vasoconstrictors
    1. Terlipressin: 0.5-1mg q 4-6 IV us 5-15d
    2. Norepi: 0.5-3mg/hr to increase MAP by 10mmHg
    3. Midrodrine: 7.5mg PO tid with Octreotide 100mcg sq
  2. Albumin: 1-1.5g/kg with one of above
  3. Other:
    1. TIPS, renal replacement therapy

Disposition

  1. 1-month survival: 50%
  2. 6-month survival: 20%

Source

  • NEJM vol 361 no 13 P. Gines
  • Tintinalli