HEPATORENAL SYNDROME HRS Flashcards
What is HRS?
A potentially reversible syndrome in patients with cirrhosis, ascites, and liver failure, characterized by impaired kidney function and intense overactivity of endogenous vasoactive systems.
What are the types of HRS?
- Type 1 (AKI-HRS): Rapidly progressive kidney failure, often following a precipitating event.
- Type 2: Moderate kidney failure, evolving slowly over weeks to months.
What was the annual incidence of HRS in cirrhotic patients with ascites in 1993?
8% annually.
What was the prevalence of HRS at 5 years in 2006?
11.4%.
What leads to a reduction in effective arterial blood volume in HRS?
Splanchnic vasodilation leads to insufficient systemic circulation.
What activates renal vasoconstriction in HRS?
Activation of RAAS, sympathetic nervous system, and vasopressin release.
What is the role of portal hypertension in HRS?
Increased portal pressure reduces renal blood flow via hepatorenal reflex.
What are the clinical presentations of Type 1 HRS?
- Rapidly progressive kidney failure
- Severe jaundice
- Coagulopathy
- Liver failure
What are common precipitating factors for HRS?
- Volume depletion
- Worsening vasodilation
What does the IAC criteria define as AKI?
Increase in serum creatinine by 0.3 mg/dL in <48 hours or 50% increase in 7 days.
What are common biomarkers used to differentiate structural vs. functional AKI?
- NGAL
- IL-18
- KIM-1
- L-FABP
What is the most common cause of AKI in cirrhosis?
Prerenal Azotemia.
What are the general measures for treating HRS?
- Treat infections
- Discontinue nephrotoxic drugs
- Correct volume depletion
What is the first-line vasoconstrictor agent for HRS?
Terlipressin.
What is the prognosis for untreated Type 1 HRS?
2-week mortality up to 80%.
What is the median survival for Type 2 HRS?
3-6 months.
Fill in the blank: HRS is a functional AKI in cirrhosis with _______.
circulatory dysfunction.
True or False: Dialysis provides long-term survival benefit without liver transplantation in HRS.
False.
What preventative measures can reduce kidney impairment in HRS?
- SBP prophylaxis with albumin and antibiotics
- Albumin infusion following large-volume paracentesis
- Prophylactic antibiotics for gastrointestinal bleeds
