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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 ... #Syndrome #HRS ... #nephrology
Causes of Hyponatremia - Differential Diagnosis Algorithm
Syndrome of Inappropriate ADH - Euvolemic; no physiologic stimulus to
Algorithm Syndrome ... especially thiazide diuretics ... heart failure • Cirrhosis ... • Reduced GFR, AKI ... #Hyponatremia #Nephrology
Causes of Hyponatremia - Differential Diagnosis Algorithm
Syndrome of Inappropriate ADH - Euvolemic; no physiologic stimulus to
Algorithm Syndrome ... especially thiazide diuretics ... heart failure • Cirrhosis ... • Reduced GFR, AKI ... #Hyponatremia #Nephrology
Physiologic Approach to Hypotonic Hyponatremia
The next time you have a case of hypotonic hyponatremia, give the
normal volume-based algorithm ... , Post-AKI diuresis ... Heart failure, Cirrhosis ... , Nephrotic syndrome ... #differential #diagnosis
Hepatorenal Syndrome (HRS) - Diagnostic Criteria
HRS-AKI (Acute: previously known as HRS Type 1)
 • ↑ Creatinine
Hepatorenal Syndrome ... (HRS) - Diagnostic ... Criteria HRS-AKI ... nephrotoxics (e.g. diuretics ... #diagnosis #HRSAKI
Causes of Hyponatremia - Differential Diagnosis Algorithm
Hypovolemia, UNa > 20: 
 • Renal losses, Diuretic excess,
- Differential Diagnosis ... Algorithm Hypovolemia ... Renal losses, Diuretic ... , Cirrhosis, Cardiac ... #nephrology
Diuretics and Agents Regulating Renal Excretion

Carbonic Anhydrase Inhibitors (Acetazolamide, Dichlorphenamide)
 • Glaucoma
 • Epilepsy
 • Altitude
disequilibrium syndrome ... • Diagnosis of ... failure, liver cirrhosis ... and nephrotic syndrome ... #Nephrology #Pharmacology
Primary Metabolic Alkalosis - Differential Diagnosis Algorithm
Volume Depleted 2° hyperaldosteronism
 • Low Urine Cl-: Vomiting, NGT
- Differential Diagnosis ... Algorithm Volume ... Low Cl intake, Diuretics ... High Urine Cl-: Diuretics ... #Algorithm #nephrology
Causes of Generalized Edema - Differential Diagnosis Algorithm
Overfill (Increased renal sodium retention, Urine Na > 40meq/L)
- Differential Diagnosis ... Algorithm Overfill ... • NSAlDs • AKI ... • Cirrhosis ... #Algorithm #Causes
Modified Hyponatremia Algorithm
Hypertonic Hyponatremia: Hyperglycemia, Mannitol, Urologic irrigants
Hypotonic Hyponatremia: 
 • ADH ON (UOsm > 100):
Heart failure, Cirrhosis ... , Nephrotic syndrome ... , Medications (diuretics ... #diagnosis #sodium ... #nephrology