Hepatorenal syndrome Flashcards
Hepatorenal syndrome (HRS) patho
Portal HTN –> splanchnic vasodilation –> reduced effective circulating volume –> lack renal perfusion –> kidney fails
Mortality rate of HRS
95% death rate in 30 days
2-4 week survival
Goal of HRS treatment
Increase intravascular volume
Decrease splanchnic vasodilation
aka we want splanchnic vasoconstriction (in order to perfuse organ, volume already low)
Diagnosis of HRS
Cirrhosis + Ascites
SCr increase ≥ 0.3 mg/dL in 48 hrs or Scr increase ≥50% from baseline in last 7 days
(ex: Scr from 2.0 –> 2.3 in 48 hrs. or Scr 2.0 –> 3.0 in a week)
No improvement in SCr after 2 days of d/c diuretics and giving IV albumin 1g/kg/day
HRS treatment
Vasoconstrict w IV NE
Continue IV albumin 1g/kg/day to maintain volume
… liver transplant
HRS response to therapy is defined as
SCr <1.5 mg/dL
or return within 0.3 mg/dL of baseline over max 2 weeks time
Titrate off therapy once normalized
HRS treatment failure is defined as
After 4 days of therapy, SCr remains the same or increases above the pretreatment
Discontinue therapy
How does norepinephrine help in HRS?
Vasopressor = constricts peripheral
a1 and b1 effect = increase heart rate
adrenergic response = increase Q