Hepatorenal Syndrome

Question 1

Define hepato-Renal syndrome

Answer 1

Severe hepatic injury leads to a reduction in kidney perfusion

Question 2

What are common PMH diagnoses in HRS patients

Answer 2

Portal HTN d/t cirrhosis
Severe alcohol hepatitis
Metastatic tumors
Fulminant hepatic failure

Question 3

What is the Hallmark of HRS?

Answer 3

Renal vasoconstriction

Question 4

Describe the pathophysiology in HRS

Answer 4

Portal HTN triggers arterial vasodilation in splanchnic circulation, which leads to an increase in nitric oxide vasodilation. Total SVR decreases causing a decline in kidney perfusion. Renal vessels vasoconstrict.

Question 5

What are the two types of HRS and the differences between the two

Answer 5

AKI HRS: doubling serum creat >2.5 with the presence of a systemic infection
CKD HRS: Progressive and chronic, ascites is resistant to diuretics

Question 6

What is the lab diagnostics that point towards HRS

Answer 6

AKI
Azotemia with no known cause in presence of liver disease

Question 7

What are 5 major required criteria for HRS diagnosis

Answer 7

Low GFR, absence of other etiology, no sustained improvement in renal function, proteinuria <500, no US evidence of obstruction or parenchymal disease

Question 8

What are UA results that point towards HRS?

Answer 8

Low UO
NA <10
Urine osmo > plasma
RBCS<50
Serum NA <130

Question 9

What are four bridge therapy drugs in HRS

Answer 9

Terlipressin and Octreotide
Midodrine and norepinepherine

Question 10

What are oral medications that can be administered in HRS

Answer 10

Midodrine and diuretics to help make ascites sensitive to diuretics

Question 11

What are procedural treatments for HRS

Answer 11

Dialysis, TIPS procedure, Liver transplant (ULTIMATE TREATMENT)