Difference between revisions of "Hepatorenal syndrome"

m (Rossdonaldson1 moved page Hepatorenal Syndrome to Hepatorenal syndrome)
Line 3: Line 3:
 
*Often heralded by the presence of SBP
 
*Often heralded by the presence of SBP
 
*Cause is unknown
 
*Cause is unknown
 +
 +
==Clinical Features==
 +
*Type 1
 +
**Doubling of serum Cr over a 2-week period
 +
**Progressive oliguria
 +
*Type 2
 +
**Gradual impairment in renal function (that may not advance beyond moderate)
 +
Type 1 & 2 both require:
 +
*Cr >1.5mg/dl
 +
*Cr not reduced below 1.5 w/ albumin (1g/kg) and after minimum of 2 days off diuretics
 +
*Absence of current or recent rx with potentially nephrotoxic drugs
 +
*Absence of shock
 +
*Absence of renal parenchymal disease:
 +
 +
==Differential Diagnosis==
 +
*Hypovolemia-induced renal failure
 +
**[[GI bleed]]
 +
**[[Diuretics]]
 +
**[[Diarrhea]]
 +
*Parenchymal renal disease
 +
**Urinary excretion of >500mg protein/d, >50 RBC/hpf, abnl kidneys on U/S
 +
*Drug-induced renal failure ([[NSAIDs]], [[aminoglycosides]])
  
 
==Diagnosis==
 
==Diagnosis==
#Type 1
 
##Doubling of serum Cr over a 2-week period
 
##Progressive oliguria
 
#Type 2
 
##Gradual impairment in renal function (that may not advance beyond moderate)
 
#Type 1 & 2 both require:
 
##Cr >1.5mg/dl
 
##Cr not reduced below 1.5 w/ albumin (1g/kg) and after minimum of 2 days off diuretics
 
##Abscence of current or recent rx with potentially nephrotoxic drugs
 
##Abscence of shock
 
##Abscence of renal parenchymal disease:
 
  
==DDx==
 
#Hypovolemia-induced renal failure
 
##GI bleed
 
##Diuretics
 
##Diarrhea
 
#Parenchymal renal disease
 
##Urinary excretion of >500mg protein/d, >50 RBC/hpf, abnl kidneys on U/S
 
#Drug-induced renal failure (NSAIDs, aminoglycosides)
 
  
 
==Treatment==
 
==Treatment==
#Vasoconstrictors
+
*[[Vasoconstrictors]]
##Terlipressin: 0.5-1mg q 4-6 IV us 5-15d
+
**Terlipressin: 0.5-1mg q 4-6 IV us 5-15d
##Norepi: 0.5-3mg/hr to increase MAP by 10mmHg
+
**[[Norepi]]: 0.5-3mg/hr to increase MAP by 10mmHg
##Midrodrine: 7.5mg PO tid with Octreotide 100mcg sq
+
**Midrodrine: 7.5mg PO tid with Octreotide 100mcg sq
#Albumin: 1-1.5g/kg with one of above
+
*Albumin: 1-1.5g/kg with one of above
#Other:
+
*Other:
##TIPS, renal replacement therapy
+
**TIPS, renal replacement therapy
  
 
==Disposition==
 
==Disposition==
#1-month survival: 50%
+
*1-month survival: 50%
#6-month survival: 20%
+
*6-month survival: 20%
  
==Source==
+
==References==
 
*NEJM vol 361 no 13 P. Gines
 
*NEJM vol 361 no 13 P. Gines
*Tintinalli
 
  
 
[[Category:GI]]
 
[[Category:GI]]

Revision as of 19:37, 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

Clinical Features

  • Type 1
    • Doubling of serum Cr over a 2-week period
    • Progressive oliguria
  • Type 2
    • Gradual impairment in renal function (that may not advance beyond moderate)

Type 1 & 2 both require:

  • Cr >1.5mg/dl
  • Cr not reduced below 1.5 w/ albumin (1g/kg) and after minimum of 2 days off diuretics
  • Absence of current or recent rx with potentially nephrotoxic drugs
  • Absence of shock
  • Absence of renal parenchymal disease:

Differential Diagnosis

Diagnosis

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%

References

  • NEJM vol 361 no 13 P. Gines