The hepatorenal syndrome

The hepatorenal syndrome - cirrhosis chromogens,

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    The hepatorenal syndrome
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Assessing kidney function in pts with  cirrhosis Cr assays are subject to interference by  chromogens, bilirubin being the major one  There is decreased hepatic production of creatine  The edematous state that complicates end-stage  liver disease leads to large distribution of Cr in the  body and lower serum Cr concentration Complications such as variceal bleeding,  spontaneous bacterial peritonitis or sepsis lead to  increased Cr tubular excretion   Proulx et al. Nephrology Dialysis Transplantation 2005  
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HRS is a form of acute or subacute renal failure  characterized by severe renal vasoconstriction,  which develops in decompensated cirrhosis or  ALF  Nearly half of patients die within 2 weeks of this  diagnosis  The annual incidence of HRS ranges between 8%  and 40% in cirrhosis depending on the MELD  score The frequency of HRS in severe acute alcoholic  hepatitis and in fulminant liver failure is about  30% and 55%, respectively  Munoz S. Medical Clinics of North America July 2008
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Munoz S. Medical Clinics of North America July 2008
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Classification of the hepatorenal  syndrome Type 1: cirrhosis with rapidly progressive acute  renal failure  Type 2: cirrhosis with subacute renal failure  Type 3: cirrhosis with types 1 or 2 HRS  superimposed on chronic kidney disease or acute  renal injury Type 4: fulminant liver failure with HRS  Munoz S. Medical Clinics of North America July 2008
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Causes of AKI in pts with cirrhosis Acute tubular necrosis (41.7%) Pre-renal failure (38%) Hepatorenal syndrome (20%) Post-renal failure (0.3%) Moreau et al. Hepatology 2003
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Major diagnostic criteria for hepatorenal  syndrome Cirrhosis with ascites  Serum creatinine > 1.5 mg/dL  No improvement in serum creatinine (decrease to a level of  <1.5 mg/dL) after at least 2 days with diuretic withdrawal and  volume expansion with albumin. The recommended dose of  albumin is 1 g/kg of body weight per day up to a maximum of  100 g/day  Absence of shock  No current or recent treatment with nephrotoxic drugs  Absence of parenchymal kidney disease as indicated by  proteinuria >500 mg/day, microhematuria (<50 RBC/high  power field) and/or abnormal renal ultrasonography Angeli et al. Journal of Hepatology February 2008
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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The hepatorenal syndrome - cirrhosis chromogens,

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