Hepatorenal syndrome (HRS)

Reference

• Hepatology 2021;74:1014
• Gastro 2016;150:1525
• AJKD 2013;62:1198

Pathophysiology:

splanchnic vasodilation and renal vasoconstriction w/ ↓ renal blood flow

Criteria-Hepatorenal syndrome (HRS):

• HRS-AKI: development in <2 wk; usually occurs in severe liver failure, often following precipitating event (see later); median survival 2 wk
• HRS-CKD: more indolent, median survival 6 mo; liver failure present <than in HRS-AKI

Precipitants:

GIB, overdiuresis, infection, serial LVP, drugs (aminoglycosides, NSAIDs)

Treatment-Hepatorenal syndrome (HRS)(see more detail)

• Albumin + either IV vasopressors (norepi, terlipressin) or octreotide & midodrine

Reference

Acute Kidney Injury in Patients with Liver Disease | American Society of Nephrology