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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
Approach to the Hospitalized Patient with Cirrhosis
1) Recognize and Manage Decompensation
 • Ascites
 • Variceal Bleeding
Hospitalized Patient with Cirrhosis ... Alcoholic Hepatitis • Hepatorenal ... Syndrome • Prognostication ... #diagnosis #treatment ... #management
Pharmacological Treatment of Hepatorenal Syndrome (HRS)

Midodrine - Alpha agonist incr blood pressure incr renal perfusion pressure
Pharmacological Treatment ... of Hepatorenal ... Syndrome (HRS) ... #Syndrome #Nephrology ... #Management #Pharmacology
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 ... Treatment Volume ... #Syndrome #Treatment ... #management #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 ... #treatment
Hepatorenal Syndrome (HRS)

Definition:
• Functional, potentially reversible kidney impairment.
• Occurs in advanced liver disease: cirrhosis, severe alcoholic
Hepatorenal Syndrome ... liver disease: cirrhosis ... Treatment Overview ... #HRS #Hepatorenal ... #Syndrome #Hepatology
Diuretics and Agents Regulating Renal Excretion

Carbonic Anhydrase Inhibitors (Acetazolamide, Dichlorphenamide)
 • Glaucoma
 • Epilepsy
 • Altitude
disequilibrium syndrome ... irrigation • Management ... and nephrotic syndrome ... Tolvaptan) • Treatment ... Excretion #Diuresis #Nephrology
Behçet's Syndrome
Systemic disease associated with inflammation of multiple organs, small-vessel vasculitis and large-vessel vasculopathy
Epidemiology:
 • Young
response to local skin ... injury) • Neurologic ... test (this is a skin ... Arthritis, AS Treatment ... #diagnosis #management
Mycoses

HISTOPLASMOSIS
• Inhalation of conidia → Yeast → travel to lymph nodes → spread in body
• Bird
osteomyelitis or skin ... , neutropenia, cirrhosis ... Mouth, throat, skin ... ) #Mycoses #InfectiousDiseases ... Fungal #Diagnosis #Management