Hepatorenal syndrome: Difference between revisions
m (Rossdonaldson1 moved page Hepatorenal Syndrome to Hepatorenal syndrome) |
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*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== | ||
==Treatment== | ==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== | ==Disposition== | ||
*1-month survival: 50% | |||
*6-month survival: 20% | |||
== | ==References== | ||
*NEJM vol 361 no 13 P. Gines | *NEJM vol 361 no 13 P. Gines | ||
[[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
- Hypovolemia-induced renal failure
- Parenchymal renal disease
- Urinary excretion of >500mg protein/d, >50 RBC/hpf, abnl kidneys on U/S
- Drug-induced renal failure (NSAIDs, aminoglycosides)
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