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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 ... #Hepatorenal #Syndrome ... #HRS #Management ... #Algorithm #nephrology
Hepatorenal Syndrome (HRS) - Diagnostic Criteria
HRS-AKI (Acute: previously known as HRS Type 1)
 • ↑ Creatinine
Hepatorenal Syndrome ... in 3 months • Cirrhosis ... No structural kidney ... injury: No proteinuria ... #Hepatorenal #Syndrome
Indications for Albumin for Management of Cirrhosis
 • Large volume paracentesis (>5 liter) - 8g per
removed • Acute kidney ... injury (≥ 1B) - ... antibiotics • Hepatorenal ... syndrome - 1g/ ... #Management #Cirrhosis
Acute Kidney Injury - Classification
Prerenal:
 • Dehydration
 • Heart failure (a.k.a. cardiorenal syndrome)
 • Liver failure
Acute Kidney Injury ... failure (a.k.a. hepatorenal ... syndrome) Intrarenal ... vasculitis - TTP/HUS ... #diagnosis #nephrology
Pharmacological Treatment of Hepatorenal Syndrome (HRS)

Midodrine - Alpha agonist incr blood pressure incr renal perfusion pressure
Syndrome (HRS) ... amzn.to/34t5DgJ #HRS ... #HepatoRenal #Syndrome ... #Nephrology #Management ... #Pharmacology #Medications
Acute Kidney Injury (AKI) - Differential Diagnosis Framework
Pre-Renal:
 • Hypovolemia, Cardiorenal, Distributive Shock, HRS, Hypercalcemia, Renal
Acute Kidney Injury ... Distributive Shock, HRS ... Abdominal Compartment Syndrome ... , Medications Intra-Renal ... #Diagnosis #nephrology
Hepatorenal Syndrome - Diagnosis and Management Summary
Who gets HRS?
 • Decompensated cirrhosis
 • Typically with existing
Hepatorenal Syndrome ... Diagnosis and Management ... Decompensated cirrhosis ... a precipitant: Medications ... #Syndrome #HRS
Acute Kidney Injury - AKI Workup Algorithm and Differential Diagnosis
Baseline Investigations: full blood count with differential,
Acute Kidney Injury ... clinical context and signs ... pressure • TTP / HUS ... • Cardio-renal syndrome ... #Injury #AKI #Workup
Causes of Acute Kidney Injury (AKI) - Differential Diagnosis Algorithm
Acute Kidney Injury (AKI) - Acute increase
Causes of Acute Kidney ... Injury (AKI) - ... Injury (AKI) - ... Hypoperfusion • Hepatorenal ... syndromes • Drugs
Acute Kidney Injury (AKI) - Management Principles
Prerenal - Correct hemodynamic derangements:
 • If low preload →
Acute Kidney Injury ... (AKI) - Management ... - inotropes • Hepatorenal ... syndrome → Treat ... #management