Hepatorenal Syndrome & Alcoholic Liver Disease
This compensatory system is overactivated in hepatorenal syndrome and causes renal vasoconstriction.
What is the RAAS (Renin-Angiotensin-Aldosterone System)?
This is the most common cause of acute renal failure in hospitalized patients.
What is acute tubular necrosis (ATN)?
This GFR threshold defines end-stage renal disease (ESRD).
What is <15 mL/min/1.73 m²?
Azotemia refers to elevated levels of these two nitrogenous compounds.
What are BUN and creatinine?
A patient with cirrhosis and rising creatinine but bland urinalysis (no proteinuria, hematuria, or casts) likely has this condition.
What is hepatorenal syndrome?
Hepatorenal syndrome is classified as this type of renal failure based on its mechanism.
What is prerenal failure?
In ATN, these two tubular segments are most vulnerable due to high metabolic activity.
What are the proximal tubule and thick ascending limb?
This lab value progressively rises in both acute and chronic renal failure and reflects nitrogenous waste.
What is BUN (blood urea nitrogen)?
This type of azotemia is due to obstruction of urine flow.
What is postrenal azotemia?
A patient with hypotension and NSAID use has high BUN/Cr ratio and responds to IV fluids. What type of azotemia is this?
What is prerenal azotemia?
This splanchnic vascular change is a key driver of effective hypovolemia in cirrhosis.
What is vasodilation (due to nitric oxide overproduction)?
Medical vocabulary question: this metabolic derangement in acute renal failure leads to pericarditis, platelet dysfunction, and encephalopathy.
What is uremia?
Basically azotemia + symptoms.
This is the most common cause of ESRD in the United States.
What is diabetic nephropathy?
A FeNa (Fractional Excretion of Sodium) >1% is suggestive of this type of azotemia.
What is intrinsic azotemia?
This type of renal failure has evidence of tubular damage and urine with epithelial/granular casts.
What is intrinsic renal failure (specifically acute tubular necrosis)?
In alcoholic liver disease, this vasoactive substance increases renal vasoconstriction, worsening kidney perfusion.
What is endothelin?
This phase of acute tubular necrosis is characterized by oliguria and lasts about 1-3 weeks.
What is the maintenance phase?
ESRD increases mortality primarily due to disease in this organ system.
What is the cardiovascular system?
This lab ratio helps differentiate prerenal from intrinsic azotemia.
What is BUN:Creatinine ratio (>20:1 in prerenal)?
A man with prostate hypertrophy has oliguria, rising creatinine, and bilateral hydronephrosis. What diagnosis (kidney)?
What is postrenal azotemia (due to obstructive uropathy)?
This is the primary (usual) pathological finding in kidneys of patients with hepatorenal syndrome.
What is normal histology or no structural kidney damage?
In chronic renal failure, this bone-related complication arises due to phosphate retention and low vitamin D.
What is renal osteodystrophy (or secondary hyperparathyroidism)?
The two most common etiologies of chronic kidney disease (CKD) are:
What are Diabetes Mellitus (Diabetic Nephropathy) and Hypertension (Hypertensive Nephrosclerosis)
In intrinsic azotemia, such as ATN, you expect urine osmolality to be:
What is low (<350 mOsm/kg, due to inability to concentrate urine)?
This hormone imbalance explains both volume overload and hyponatremia in advanced cirrhosis with renal dysfunction.
What is inappropriate ADH secretion (leading to dilutional hyponatremia)?