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AKI in Cirrhosis - Hepatorenal Syndrome Management Algorithm

DOI: 10.1136/bmj.m2687

#AKI #Cirrhosis #Hepatorenal #Syndrome #HRS #Management #Algorithm #nephrology
AKI in Cirrhosis ... - Hepatorenal Syndrome ... Management Algorithm ... #Hepatorenal #Syndrome ... #Algorithm #nephrology
 End Stage Liver Disease (Cirrhosis) - Complications 
 • Ascites
 • Esophageal Varices
 • Hepatic
Liver Disease (Cirrhosis ... Hepatopulmonary Syndrome ... (HPS) • Hepatorenal ... Syndrom (HRS) ... Complications #diagnosis #management
Pharmacological Treatment of Hepatorenal Syndrome (HRS)

Midodrine - Alpha agonist incr blood pressure incr renal perfusion pressure
Pharmacological Treatment of Hepatorenal ... Syndrome (HRS) ... edgarvlermamd - Nephrology ... #Syndrome #Nephrology ... #Management #Pharmacology
Approach to the Hospitalized Patient with Cirrhosis
1) Recognize and Manage Decompensation
 • Ascites
 • Variceal Bleeding
Hospitalized Patient with Cirrhosis ... Alcoholic Hepatitis • Hepatorenal ... Syndrome • Prognostication ... DeanEhrlich_MD #inpatient #Cirrhosis ... diagnosis #treatment #management
Indications for Albumin for Management of Cirrhosis
 • Large volume paracentesis (>5 liter) - 8g per
for Albumin for Management ... of Cirrhosis ... antibiotics • Hepatorenal ... syndrome - 1g/ ... #Cirrhosis #treatment
Hepatorenal Syndrome Treatment
Volume expansion: 
 • Albumin (typical dose = 1g/kg on day 1 +/- day
Hepatorenal Syndrome ... EricsMedicalLectures/ #Hepatorenal ... #Syndrome #Treatment ... #management #HRS ... #nephrology
Hepatorenal Syndrome Diagnosis
 • ↑ in serum Cr of ≥ 0.3mg/dL above baseline
Hepatorenal Syndrome ... (e.g. advanced cirrhosis ... EricsMedicalLectures/ #Hepatorenal ... #Syndrome #diagnosis ... #HRS #nephrology
Hepatorenal Syndrome - Diagnosis and Management Summary
Who gets HRS?
 • Decompensated cirrhosis
 • Typically with existing
Hepatorenal Syndrome ... Diagnosis and Management ... Decompensated cirrhosis ... #Syndrome #HRS ... #Diagnosis #Management
Diuretics and Agents Regulating Renal Excretion

Carbonic Anhydrase Inhibitors (Acetazolamide, Dichlorphenamide)
 • Glaucoma
 • Epilepsy
 • Altitude
disequilibrium syndrome ... irrigation • Management ... failure, liver cirrhosis ... and nephrotic syndrome ... Excretion #Diuresis #Nephrology
Consensus Indications for Irradiated RBC Transfusions:

Cellular blood components are irradiated for the prevention of TA-GVHD. Transfused
Transfused T lymphocytes ... disorders (DiGeorge Syndrome ... #Indications #Hematology ... #BloodBank #Management