The Intern At Work: Internal Medicine 239. A Liver-Kidney Conundrum - Hepatorenal Syndrome
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Jun 2, 2024 Dr. Cynthia Tsien, a Transplant Hepatologist, discusses the acute presentation of hepatorenal syndrome, including nomenclature, epidemiology, clinical presentation, investigations, and management. The episode also reviews the utility of terlipressin in treating HRS in patients with decompensated cirrhosis.
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HRS is a deadly cirrhosis complication
- Hepatorenal syndrome (HRS) is a fatal complication of decompensated cirrhosis causing rapid kidney failure.
- Early diagnosis and management are crucial due to high mortality without liver transplantation.
Physiology behind HRS AKI
- Cirrhosis leads to portal hypertension causing systemic vasodilation and decreased effective circulating volume.
- Kidney compensatory vasoconstriction and fluid retention maintain function but are fragile and easily tipped into AKI.
Systematic evaluation of HRS patient
- Evaluate vitals carefully to distinguish baseline hypotension from life-threatening causes like sepsis or bleeding.
- Identify precipitating factors and assess for underlying kidney disease, nephrotoxic medications, and recent paracentesis.