UMEM Educational Pearls

Category: Critical Care

Title: Hepatorenal Syndrome

Posted: 8/27/2024 by Mike Winters, MBA, MD (Updated: 10/29/2024)
Click here to contact Mike Winters, MBA, MD

Hepatorenal Syndrome

  • Emergency physicians evaluate patients with cirrhosis and ascites daily.
  • Patients with cirrhosis are particularly susceptible to acute kidney injury (AKI), which is associated with a significant increase in hospital mortality.
  • Hepatorenal syndrome (HRS) is a specific type of renal dysfunction in patients with cirrhosis and ascites.
  • The previous classification of HRS (Type 1, Type 2) has now been replaced by HRS-AKI, HRS-AKD, and HRS-CKD.
  • The diagnostic criteria for HRS-AKI include:
    • Increase in creatinine 0.3 mg/dL within 48 hrs or 50% from baseline value within the prior 7 days
    • Lack of improvement in creatinine or urine output within 24 hrs of adequate volume resuscitation
    • Absence of an alternative explanation for AKI
  • Management of HRS-AKI centers on accurate volume assessment, timely administration of a splanchnic vasoconstrictor (norepinephrine), administration of 20-25% albumin, and avoidance of additional nephrotoxins.

References

Nadim M, et al. Hepatorenal syndrome in the intensive care unit. Intensive Care Med. 2024; 50:978-981.