Difference between revisions of "Hepatorenal syndrome"

(Treatment)
(Disposition)
Line 41: Line 41:
 
*1-month survival: 50%
 
*1-month survival: 50%
 
*6-month survival: 20%
 
*6-month survival: 20%
 +
 +
==See Also==
  
 
==References==
 
==References==

Revision as of 19:38, 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
    • Norepinepherine: 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%

See Also

References

  • NEJM vol 361 no 13 P. Gines