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AKI in Cirrhosis - Hepatorenal Syndrome Management Algorithm

DOI: 10.1136/bmj.m2687

#AKI #Cirrhosis #Hepatorenal #Syndrome #HRS #Management #Algorithm #nephrology
in Cirrhosis - Hepatorenal ... Syndrome Management ... #Syndrome #HRS ... #Management #Algorithm ... #nephrology
Pharmacological Treatment of Hepatorenal Syndrome (HRS)

Midodrine - Alpha agonist incr blood pressure incr renal perfusion pressure
Syndrome (HRS) ... edgarvlermamd - Nephrology ... #Syndrome #Nephrology ... #Management #Pharmacology ... #Medications #Treatment
Hepatorenal Syndrome Treatment
Volume expansion: 
 • Albumin (typical dose = 1g/kg on day 1 +/- day
Hepatorenal Syndrome ... Albumin (typical dose ... #Syndrome #Treatment ... #management #HRS ... #nephrology
Hepatorenal Syndrome - Diagnosis and Management Summary
Who gets HRS?
 • Decompensated cirrhosis
 • Typically with existing
Hepatorenal Syndrome ... Diagnosis and Management ... a precipitant: Medications ... #Syndrome #HRS ... #Diagnosis #Management
Stress Dose Steroids - Indications and Dosing

SUPPRESSED HPA AXIS:
 prednisone >20mg/day x 3 weeks or more
Stress Dose Steroids ... - Indications and ... StressDose #Steroids #Indications ... #Dosing #Endocrinology ... #Diagnosis #Management
DPP4 Inhibitors - Normal and Renal Dosing

Increase Incretins (GLP-I & GIP) -> Stimulates Insulin, Inhibits Glucagon
on the highest dose ... different than other medications ... very tolerable medication ... #Pharmacology #Management ... Diabetes #DM2 #Endocrinology
Indications for Albumin for Management of Cirrhosis
 • Large volume paracentesis (>5 liter) - 8g per
Indications for ... Albumin for Management ... antibiotics • Hepatorenal ... syndrome - 1g/ ... #Management #Cirrhosis
Hepatorenal Syndrome Diagnosis
 • ↑ in serum Cr of ≥ 0.3mg/dL above baseline
Hepatorenal Syndrome ... giving IV fluids does ... EricsMedicalLectures/ #Hepatorenal ... #Syndrome #diagnosis ... #HRS #nephrology
Acute Kidney Injury - Classification
Prerenal:
 • Dehydration
 • Heart failure (a.k.a. cardiorenal syndrome)
 • Liver failure
a.k.a. cardiorenal syndrome ... failure (a.k.a. hepatorenal ... syndrome) Intrarenal ... tract infection • Medications ... Classification #diagnosis #nephrology
Cushing Syndrome Testing Algorithm
INDICATIONS FOR TESTING:
 • Suspected Cushing syndrome (central obesity, muscle weakness, refractory hypertension)
Testing:
Cushing Syndrome ... Testing Algorithm INDICATIONS ... Suspected Cushing syndrome ... Saliva • Low dose ... diagnosis #algorithm #endocrinology