10 Questions
What is hepatorenal syndrome (HRS)?
A unique type of kidney injury that occurs in patients with cirrhosis and ascites.
What is the pathophysiology behind hepatorenal syndrome (HRS)?
Likely due to splanchnic vasodilation in the setting of portal hypertension.
What are the two subtypes of hepatorenal syndrome (HRS)?
HRS-acute kidney injury (HRS-AKI) and HRS-non-acute kidney injury (HRS-NAKI).
What is the only curative treatment for hepatorenal syndrome (HRS)?
Liver transplant.
How may hepatorenal syndrome (HRS) be pharmacologically mitigated?
With vasoconstrictors and albumin.
What is the etiology of hepatorenal syndrome (HRS)?
Complication of liver failure, especially cirrhosis.
What does HRS-acute kidney injury (HRS-AKI) refer to?
Acute kidney injury in patients with cirrhosis; formerly known as type 1 HRS.
What does HRS-non-acute kidney injury (HRS-NAKI) refer to?
Functional kidney injury in patients with cirrhosis not meeting the criteria for HRS-AKI; formerly known as type 2 HRS.
What is the diagnostic approach for hepatorenal syndrome (HRS)?
It is a diagnosis of exclusion and requires the elimination of other potential etiologies, including hypovolemia.
What is the likely cause of hepatorenal syndrome (HRS) in the setting of portal hypertension?
Splanchnic vasodilation.
Study Notes
Hepatorenal Syndrome (HRS)
- Hepatorenal syndrome (HRS) is a complication of advanced liver disease, characterized by progressive renal failure and marked abnormalities in the kidneys.
Pathophysiology
- The pathophysiology of HRS involves a complex interplay of splanchnic vasodilation, decreased effective arterial blood volume, and activation of the renin-angiotensin-aldosterone system, leading to renal vasoconstriction and reduced glomerular filtration rate.
Subtypes
- There are two subtypes of HRS: HRS-acute kidney injury (HRS-AKI) and HRS-non-acute kidney injury (HRS-NAKI).
- HRS-AKI is a type of HRS that develops rapidly, usually within 1-2 weeks, and is often precipitated by a sudden event such as infection or bleeding.
- HRS-NAKI is a type of HRS that develops slowly, often over weeks or months, and is not precipitated by a specific event.
Treatment
- The only curative treatment for HRS is liver transplantation.
- Pharmacological mitigation of HRS may be achieved with the use of vasoconstrictors, such as terlipressin or midodrine, and albumin infusion.
Etiology
- The etiology of HRS is related to advanced liver disease, particularly in the setting of cirrhosis and portal hypertension.
Diagnostic Approach
- The diagnostic approach for HRS involves a combination of clinical and laboratory evaluation, including measurements of serum creatinine, urine output, and electrolytes.
Pathogenesis
- In the setting of portal hypertension, the likely cause of HRS is the presence of splanchnic vasodilation, which leads to decreased effective arterial blood volume and activation of the renin-angiotensin-aldosterone system.
Test your knowledge about the unique type of kidney injury that occurs in patients with cirrhosis and ascites, known as Hepatorenal syndrome (HRS), including its pathophysiology, subtypes, and diagnostic approach.
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