Hepatorenal Syndrome (HRS)

Question 1

causes

Answer 1

splanchnic dilation secondary to portal HTN results in dec ECV, dec renal perfusion of blood and O2
high mortality rate
95% die within 30d
2-4 wek survival on average
last stage of cirrhosis
need liver transplant

Question 2

dx

Answer 2

cirrhosis w ascites
SCR inc >0.3 in 48 h or inc >/=50% from baseline in last 7d

no improvement in SCr after 2d of diuretic and IV albumin

Question 3

tx and purpose

Answer 3

bridge to transplant

IV NE + IV albumin 1g/kg/day
dc at 4d if no change in SCr or SCr increased

Question 4

what is deemed as a response to HRS treatment with NE and IV Albumin

Answer 4

SCr decreases to <1.5 or returns to within 0.3 of baseline within =2weeks

Question 5

when do we use albumin (overall)?

Answer 5

1. Large volume paracentesis for treatment of ascites (only if removing >5L fluid)
2. SBP in addition to antibiotics (empiric–>directed)
3. 5g/kg/d day 1, 1g/kg day 3 to reduce mortality
4. HRS in addition to NE to bridge to transplant 1g/kg/d