Portal Combat
This common complication of cirrhosis involves fluid accumulation in the peritoneal cavity.
What is ascites?
In hepatorenal syndrome, this waste product is elevated due to decreased renal clearance.
What is creatinine?
The perceived drop in circulating volume activates this hormonal system, leading to vasoconstriction and sodium retention.
This mineral should be restricted to less than 2 grams per day in patients with ascites
What is Na?
This is usually the first Sx noticed in functional AKI.
What is Oliguria?
This type of kidney dysfunction occurs in advanced cirrhosis and is often associated with refractory ascites.
What is hepatorenal syndrome?
In HRS, the urine sodium typically goes in this direction.
Bonus:
What do you expect the FeNa to be?
Urine Na = 5 mEq/L
Plasma Na = 130 mEq/L
Plasma Creatinine (P_Cr) = 2.5 mg/dL
Urine Creatinine (U_Cr) = 160 mg/dL
What is down?
what is <1%?
indicates Na and Water retention.
In hepatorenal syndrome, kidney structure remains normal, but this renal blood flow parameter is decreased.
What is glomerular filtration rate (GFR)?
Patients with cirrhosis should avoid this substance, which accelerates liver damage.
What is alcohol?
On physical exam, these two signs are often seen in volume-depleted patients with functional AKI.
I will accept a few if they are correct :)
What are hypotension and dry mucous membranes?
This physical exam technique helps confirm the presence of this ascites.
What is shifting dullness?
This measure of urine concentration (osm) usually goes in what direction in HRS?
What is up?
B/c incr H2O reab --> concentrates the urine
This is the qualifying term of AKI secondary to HRS.
Functional or dysfunctional AKI.
What is functional AKI?
This diuretic is typically the first-line drug used to manage ascites
What is spironolactone?
Can add loops if spironolactone is not enough?
This is the direction of BUN:creatinine ratio in prerenal AKI.
What is up?
This large-volume procedure can temporarily relieve symptomatic ascites but must be accompanied by albumin replacement to avoid hypotension.
What is paracentesis?
Unlike acute tubular necrosis, this element is usually absent in HRS urinalysis.
Bonus if you can tell me why?
What are granular casts (or muddy brown casts)?
There is no tubular damage in early HRS.
Despite reduced kidney function, the absence of this urinalysis finding helps distinguish HRS from intrinsic AKI.
What is proteinuria (or cellular casts)?
In spontaneous bacterial peritonitis, IV albumin is given with this class of antibiotics to prevent renal failure.
What is 3rd gen cephasporins?
Name them all JK :)
This calculated index distinguishes prerenal AKI from intrinsic renal injury.
And what should the value be?
<1% b/c kidneys are still fxning
This term refers to ascites that does not respond to sodium restriction and diuretics.
What is refractory ascites?
HRS often presents with a low level of this serum protein.
What is albumin?
Use of this common diuretic class can worsen renal perfusion in cirrhosis.
There are 2 possible, 1 is better. If you give me the worse one, you have to explain why the other is better for points.
What are loop diuretics?
This procedure reduces portal hypertension by creating a shunt between the portal and hepatic veins.
What is TIPS (transjugular intrahepatic portosystemic shunt)?
This broad class of medications should be held during functional AKI, as they may worsen renal perfusion.
What are NSAIDs/ACEi?