Hepatorenal syndrome

Question 1

Hepatorenal syndrome (HRS) patho

Answer 1

Portal HTN –> splanchnic vasodilation –> reduced effective circulating volume –> lack renal perfusion –> kidney fails

Question 2

Mortality rate of HRS

Answer 2

95% death rate in 30 days
2-4 week survival

Question 3

Goal of HRS treatment

Answer 3

Increase intravascular volume
Decrease splanchnic vasodilation
aka we want splanchnic vasoconstriction (in order to perfuse organ, volume already low)

Question 4

Diagnosis of HRS

Answer 4

Cirrhosis + Ascites
SCr increase ≥ 0.3 mg/dL in 48 hrs or Scr increase ≥50% from baseline in last 7 days
(ex: Scr from 2.0 –> 2.3 in 48 hrs. or Scr 2.0 –> 3.0 in a week)
No improvement in SCr after 2 days of d/c diuretics and giving IV albumin 1g/kg/day

Question 5

HRS treatment

Answer 5

Vasoconstrict w IV NE
Continue IV albumin 1g/kg/day to maintain volume

… liver transplant

Question 6

HRS response to therapy is defined as

Answer 6

SCr <1.5 mg/dL
or return within 0.3 mg/dL of baseline over max 2 weeks time

Titrate off therapy once normalized

Question 7

HRS treatment failure is defined as

Answer 7

After 4 days of therapy, SCr remains the same or increases above the pretreatment
Discontinue therapy

Question 8

How does norepinephrine help in HRS?

Answer 8

Vasopressor = constricts peripheral
a1 and b1 effect = increase heart rate
adrenergic response = increase Q