Hepatorenal syndrome

Question 1

Define hepatorenal syndrome

Answer 1

occurrence of renal failure in a patient with advanced liver disease in the absence of an identifiable cause of renal failure

marked reduction in eGFR and increase in creatinine in absence of alteration in kidney histology

Question 2

What are the 2 patterns of hepatorenal syndrome?

Answer 2

AKI-HRS (Type 1)
CKD-HRS (Type 2)

Question 3

Precipitating factors of hepatorenal syndrome

Answer 3

bacterial infection
GI haemorrhage
large volume paracentesis
diuretics

Question 4

Hepatorenal syndrome management

Answer 4

assess clinical status - fluid balance, obs, urine output etc

screen for infection - blood/urine/ascites culture, CXR, inspect skin

suspend diuretics

suspend beta blockers?

Albumin

Terlipressin (splanchnic vasocompression)

renal replacement therapy

simultaneous liver and kidney transplant