Pathophys
HRS occurs in patients with advanced this underlying organ disease.
What is cirrhosis?
HRS is a diagnosis of exclusion requiring cirrhosis and this major clinical feature.
What is acute kidney injury?
HRS-AKI was formerly known as this.
What is Type 1 HRS?
First-line pharmacologic therapy for HRS in the U.S. includes albumin plus this vasoconstrictor.
What is terlipressin?
FeNa in HRS is typically less than this percentage.
What is <1%?
The primary hemodynamic abnormality in HRS is severe vasodilation in this vascular bed.
What is the splanchnic circulation?
Before diagnosing HRS-AKI, patients must fail to improve after volume expansion with this substance.
What is albumin?
This type of HRS is characterized by more gradual kidney decline and refractory ascites.
What is HRS-NAKI (formerly Type 2)?
If terlipressin is unavailable, this combination therapy is often used on the wards.
What is midodrine and octreotide (with albumin)?
Diuretics should be stopped during evaluation of AKI in cirrhosis to help rule out this cause.
What is prerenal azotemia?
Splanchnic vasodilation leads to decreased effective arterial blood volume, activating these three systems.
What are RAAS, sympathetic nervous system, and ADH?
A urine sodium typically less than this value supports HRS physiology.
What is <20 mEq/L?
HRS-AKI is commonly precipitated by this infection in cirrhotic patients.
What is spontaneous bacterial peritonitis (SBP)?
This IV vasopressor is commonly used in ICU settings as an alternative therapy.
What is norepinephrine?
Bilirubin levels are often markedly elevated in HRS because of this underlying process.
What is advanced liver failure?
Despite severe kidney dysfunction in HRS, kidney histology typically shows this.
What is normal kidney structure (no intrinsic renal disease)?
Active urine sediment with RBC casts suggests this instead of HRS.
What is glomerulonephritis?
Large-volume paracentesis without albumin replacement can precipitate this complication.
What is hepatorenal syndrome?
The definitive treatment for HRS is this.
What is liver transplantation?
HRS carries a very poor prognosis, with untreated Type 1 historically having a median survival of approximately this long.
What is about 2 weeks?
This mediator, increased in portal hypertension, contributes to splanchnic vasodilation in HRS.
What is nitric oxide?
According to modern definitions (International Club of Ascites), HRS-AKI is defined by a rise in creatinine of at least this amount within 48 hours.
What is ≥0.3 mg/dL?
This condition must be ruled out before diagnosing HRS in a cirrhotic patient with shock.
What is septic shock (or hypovolemia)?
Renal replacement therapy in HRS is typically used as a bridge to this intervention rather than as definitive therapy.
What is liver transplant?
This scoring system is used to prioritize patients with HRS for liver transplant allocation.
What is the MELD score?