Hepatorenal syndrome Flashcards

1
Q

Hepatorenal syndrome (HRS) patho

A

Portal HTN –> splanchnic vasodilation –> reduced effective circulating volume –> lack renal perfusion –> kidney fails

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2
Q

Mortality rate of HRS

A

95% death rate in 30 days
2-4 week survival

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3
Q

Goal of HRS treatment

A

Increase intravascular volume
Decrease splanchnic vasodilation
aka we want splanchnic vasoconstriction (in order to perfuse organ, volume already low)

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4
Q

Diagnosis of HRS

A

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

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5
Q

HRS treatment

A

Vasoconstrict w IV NE
Continue IV albumin 1g/kg/day to maintain volume

… liver transplant

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6
Q

HRS response to therapy is defined as

A

SCr <1.5 mg/dL
or return within 0.3 mg/dL of baseline over max 2 weeks time

Titrate off therapy once normalized

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7
Q

HRS treatment failure is defined as

A

After 4 days of therapy, SCr remains the same or increases above the pretreatment
Discontinue therapy

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8
Q

How does norepinephrine help in HRS?

A

Vasopressor = constricts peripheral
a1 and b1 effect = increase heart rate
adrenergic response = increase Q

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