Hepatorenal syndrome: Difference between revisions
No edit summary |
No edit summary |
||
Line 1: | Line 1: | ||
== | ==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== | ==Diagnosis== | ||
#Type 1 | #Type 1 | ||
#Type 2 | ##Doubling of serum Cr over a 2-week period | ||
#Type 1 & 2 both require | ##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 >1.5mg/dl | ||
##Cr | ##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 current or recent rx with potentially nephrotoxic drugs | ||
##Abscence of shock | ##Abscence of shock | ||
##Abscence of renal parenchymal disease | ##Abscence of renal parenchymal disease: | ||
==DDx== | ==DDx== | ||
#Hypovolemia-induced renal failure | #Hypovolemia-induced renal failure | ||
#Parenchymal renal disease | ##GI bleed | ||
#Drug-induced renal failure ( | ##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== | ||
Line 23: | Line 32: | ||
##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: TIPS, renal replacement therapy | #Other: | ||
##TIPS, renal replacement therapy | |||
==Disposition== | ==Disposition== | ||
Line 30: | Line 40: | ||
==Source== | ==Source== | ||
*NEJM vol 361 no 13 P. Gines | |||
*Tintinalli | |||
[[Category:GI]] | [[Category:GI]] |
Revision as of 06:06, 1 August 2011
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
- 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
- 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
- NEJM vol 361 no 13 P. Gines
- Tintinalli