Renal. Hepatorenal + rhabdomyolysis (07-25) (1)

Question 1

Hepatorenal. simple definition?

Answer 1

Acute renal failure due to hepatic cause, eg cirrhosis.

In general complication of end stage hepatic disease

Question 2

Hepatorenal. Characterized by 3?

Answer 2

significant decr. GFR in the absence of another clear cause of renal dysfunction

Minimal hematuria (<50rbc/hpf)

Lack of improvement with volume resuscitation

Question 3

Hepatorenal. pathophysiology in cirrhosis?

Answer 3

cirrhosis –> splanchnic arterial dilation (due to incr. NO release in splanchnic circulation due to portal hypertension) -> decr. vascular resistance –> activation of RAAS –> renal vasoconstriction –> decr. perfusion and GFR

Question 4

Hepatorenal. 2 most common inciting factors?

Answer 4

Spontaneous bacterial peritonitis
GI bleeding

Question 5

Hepatorenal. what is response to standard renal treatment?

Answer 5

do not respond to Iv fluids and withdrawal of diurestics, and renal function continues to decline

Question 6

Hepatorenal. table. risk factors?

Answer 6

advanced cirrhosis with portal hypertension and edema

Question 7

Hepatorenal. table. precipitating factors? 4

Answer 7

reduced renal perfusion

GI bleeding, vomiting, sepsis, excessive diuretic use, spontaneous bacterial peritonitis

Reduced glomerular pressure and GFR (NSAIDs use –> constricts afferent arterioles)

Question 8

Hepatorenal. table. diagnosis 5?

Answer 8

Renal hypoperfusion
FeNa< 1proc. (or urine Na < 10 mEq/L)
Absence of tubular injury
No RBC, protein, or granular casts in urine
No improvement in renal function with fluids

Question 9

Hepatorenal. table. treatment? 3

Answer 9

address predisposing factors (hypovolemia, anemia, infection)

Splanchnic vasoconstrictors (midodrine, octreotide, NoA)

Liver transplantation

Question 10

UW. Rhabdomyolysis.
etiology? 3

Answer 10

Skeletal muscle lysis/necrosis due to:

a) Crush injury or prolonged immobilization

b) Intense muscle pain activity (seizure, exertion)

c) Drug/medication toxicity (eg statin)

Question 11

UW. Rhabdomyolysis.
Clinical features. 5

Answer 11

Muscle pain and weakness

Dark urine (myoglobinuria/pigmenturia)

+blood on urinalysis and no RBC on microscopy

Incr. serum K and PO4, decr. serum Ca, incr. AST>ALT

Acute kidney injury

Question 12

UW. Rhabdomyolysis.
Diagnosis? 2

Answer 12

CK > 1000 U/l
consistent clinical features

Question 13

UW. Rhabdomyolysis. management?

Answer 13

aggressive IV resuscitation

Sodium bicarbonate in some cases

Question 14

UW. Rhabdomyolysis.
drug induced.

Direct myotoxic - 4?

Answer 14

Statins, fibrates
Colchicine
Ethanol
Cocaine

Question 15

UW. Rhabdomyolysis.
drug induced.

Vasoconstrictiive ischemia - 2?

Answer 15

Cocaine
Amphetamines

Question 16

UW. Rhabdomyolysis.drug induced.

Prolonged immobilization (compression ichemia) - 3?

Answer 16

ethanol
opioids
BZD

Question 17

UW. Rhabdomyolysis.
Opioids and other CNS depressants (ethanol, BZD) –> mechanism in general?

Answer 17

induce impaired consciousness with prolonged immobilization and ischemic compression of dependent areas of skeletal muscles (mottled skin over back, buttocks, posterior thighs)

Question 18

UW. Rhabdomyolysis.
Patho on renal?

Answer 18

intravascular volume depletion followed by direct tubular toxicity of
heme (pigment nephropathy).

Question 19

UW. Rhabdomyolysis. why hypocalcemia?

Answer 19

Hypocalcemia due to precipitation of calcium and phosphorus in damaged muscles.

Question 20

UW. Rhabdomyolysis. why incr. AST?

Answer 20

Aminotransferases will be elevated; mainly AST since its found in the skeletal muscle.

Question 21

UW. Rhabdomyolysis.
Why need to monitor affected muscle groups?

Answer 21

Monitor muscle groups affected closely due to risk of acute compartment syndrome.