The Curbsiders Internal Medicine Podcast

REBOOT #145 Hepatorenal Syndrome

25 snips
Mar 28, 2022
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ANECDOTE

Kidney‑Focused Clinician And Educator

  • Joel Topf described his dual academic and private practice life and his Twitter persona 'kidney_boy'.
  • He uses teaching roles at William Beaumont Oakland and Ascension Saint John to educate students and trainees.
ADVICE

Systematic Initial AKI Workup

  • Start the AKI workup in cirrhosis with urinalysis and urine sodium/FENa to categorize injury patterns.
  • Use a volume challenge if pre-renal is suspected and escalate if no response to test for hepatorenal physiology.
INSIGHT

Low Urine Sodium Is Not Definitive

  • A low urine sodium or low FENa in cirrhosis is common and nondiagnostic by itself.
  • Interpret urine tests cautiously because bilirubin and concentrated urine can stain hyaline casts and mimic ATN.
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