Hepatorenal syndrome: Difference between revisions
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*[[Vasoconstrictors]] | *[[Vasoconstrictors]] | ||
**Terlipressin: 0.5-1mg q 4-6 IV us 5-15d | **Terlipressin: 0.5-1mg q 4-6 IV us 5-15d | ||
**[[ | **[[Norepinepherine]]: 0.5-3mg/hr to increase MAP by 10mmHg | ||
**Midrodrine: 7.5mg PO tid with Octreotide 100mcg sq | **Midrodrine: 7.5mg PO tid with Octreotide 100mcg sq | ||
*Albumin: 1-1.5g/kg with one of above | *Albumin: 1-1.5g/kg with one of above | ||
Revision as of 19:37, 11 May 2015
Background
- Acute renal failure in pt w/ nl kidneys in presence of acute/chronic hepatic failure
- Often heralded by the presence of SBP
- Cause is unknown
Clinical Features
- Type 1
- Doubling of serum Cr over a 2-week period
- Progressive oliguria
- Type 2
- Gradual impairment in renal function (that may not advance beyond moderate)
Type 1 & 2 both require:
- Cr >1.5mg/dl
- Cr not reduced below 1.5 w/ albumin (1g/kg) and after minimum of 2 days off diuretics
- Absence of current or recent rx with potentially nephrotoxic drugs
- Absence of shock
- Absence of renal parenchymal disease:
Differential Diagnosis
- Hypovolemia-induced renal failure
- Parenchymal renal disease
- Urinary excretion of >500mg protein/d, >50 RBC/hpf, abnl kidneys on U/S
- Drug-induced renal failure (NSAIDs, aminoglycosides)
Diagnosis
Treatment
- Vasoconstrictors
- Terlipressin: 0.5-1mg q 4-6 IV us 5-15d
- Norepinepherine: 0.5-3mg/hr to increase MAP by 10mmHg
- Midrodrine: 7.5mg PO tid with Octreotide 100mcg sq
- Albumin: 1-1.5g/kg with one of above
- Other:
- TIPS, renal replacement therapy
Disposition
- 1-month survival: 50%
- 6-month survival: 20%
References
- NEJM vol 361 no 13 P. Gines