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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 ... #HRS #Management ... #Algorithm #nephrology
Acute Kidney Injury (AKI) - Differential Diagnosis Framework
Pre-Renal:
 • Hypovolemia, Cardiorenal, Distributive Shock, HRS, Hypercalcemia, Renal
Kidney Injury (AKI ... Abdominal Compartment Syndrome ... Medicine @SCVMCMed #AKI ... Differential #Diagnosis #nephrology ... #causes #algorithm
Hypokalemia - Differential Diagnosis Algorithm

Transcellular Shift:
 • Alkalosis
 • ↑ beta-2 adrenergic simulation 
 • Erythropoiesis
• Refeeding syndrome ... Thyrotoxicosis Medications ... vomiting) • Low ... #nephrology #low ... #potassium
Hypokalemia - Differential Diagnosis Algorithm
Extra-renal Losses:
 • Normal Acid-Base: Low intake
 • Metabolic acidosis: Gl tract
Differential Diagnosis Algorithm ... Normal Acid-Base: Low ... Differential #Diagnosis #Algorithm ... #causes #potassium ... #low #nephrology
Causes of Hyponatremia - Differential Diagnosis Algorithm
Syndrome of Inappropriate ADH - Euvolemic; no physiologic stimulus to
Differential Diagnosis Algorithm ... Syndrome of Inappropriate ... trauma • Drugs ... • Reduced GFR, AKI ... #Hyponatremia #Nephrology
Causes of Hyponatremia - Differential Diagnosis Algorithm
Syndrome of Inappropriate ADH - Euvolemic; no physiologic stimulus to
Differential Diagnosis Algorithm ... Syndrome of Inappropriate ... trauma • Drugs ... • Reduced GFR, AKI ... #Hyponatremia #Nephrology
Hypokalemia Differential Diagnosis Algorithm
Hypertensive:
 • High Al, Low R - Primary aldosteronism
 • High Al, High
Differential Diagnosis Algorithm ... Hypertensive: • High Al, Low ... Differential #Diagnosis #Algorithm ... #nephrology #causes ... #low #potassium
Modified Hyponatremia Algorithm
Hypertonic Hyponatremia: Hyperglycemia, Mannitol, Urologic irrigants
Hypotonic Hyponatremia: 
 • ADH ON (UOsm > 100):
Cirrhosis, Nephrotic syndrome ... > 30): SIADH, Medications ... Primary polydipsia, Low ... #diagnosis #sodium ... #nephrology
Physiologic Approach to Hypotonic Hyponatremia
The next time you have a case of hypotonic hyponatremia, give the
normal volume-based algorithm ... : SIADH, Renal Sodium ... can be high or low ... Cirrhosis, Nephrotic syndrome ... #nephrology
Workup of Hypercalcemia - Differential Diagnosis Algorithm
High or Normal PTH:
 • Hyperparathyroidism: Parathyroid adenoma, Parathyroid hyperplasia,
Differential Diagnosis Algorithm ... Hypercalcemia Low ... PTHrP: - Low ... Immobilization, Drugs ... #Workup #nephrology