Hepatorenal syndrome

Question 1

What is the proposed pathophysiologic basis for hepatorenal syndrome?

Answer 1

1. vasoactive mediators cause splanchnic vasodilation
2. reduces splanchnic vascular resistance
3. this results in “underfilling” of kindeys
4. kidneys adjust by vasoconstricting and activation of RAAS but ultimately insufficient to overcome vasodilatory forces

Question 2

How many types of HRS are there?

Answer 2

Two

Question 3

What is HRS type 1?

Answer 3

Onset within 2 weeks
After physiological insult
Rapidly progressive
Doubling of serum creatinine to > 221 µmol/L or a halving of the creatinine clearance to less than 20 ml/min over a period of less than 2 weeks
Very poor prognosis

Question 4

What is HRS 2?

Answer 4

Slowly progressive

Prognosis poor, but patients may live for longer

Question 5

What is the treatment for HRS?

Answer 5

Difficult
Volume expansion
?terlipressin
TIPS

Question 6

What are features of urinary sodium in HRS

Answer 6

Low (<10mEq)

FENa (<1%)

Question 7

How do you differentiate between HRS and hypovolaemia?

Answer 7

Creat and urine output should improve with fluid challenge if hypovolaemia is primary process
It will not in HRS