Hepatorenal Pathology
This hallmark feature of HRS is due to poor renal perfusion and leads to rising creatinine without structural kidney damage.
What is acute kidney injury (AKI)?
This is the most consistent laboratory finding in hepatorenal syndrome, reflecting impaired renal filtration.
what is increased creatinine?
This a1 adronergic agonist can be given IV in acute care setting to offset the vasodilation caused by cirrhosis of the liver.
This is the most common causative organism of spontaneous bacterial peritonitis in cirrhotic patients.
What is Escherichia coli?
Patients with reversible kidney injury from liver disease typically receive this type of transplant.
Liver transplant alone
This hormone is elevated in HRS and promotes sodium and water retention via its action on the distal nephron.
What is aldosterone
This measure of renal function is typically low in HRS, reflecting intense sodium retention.
what is a low FeNA
This therapy is used as a supportive bridge in patients with volume overload or awaiting transplant.
What is Dialysis?
The presence of this WBC subtype in ascitic fluid is used to diagnose SBP (what did our patient have in the peritoneal fluid culture?)
What are polymorphonuclear leukocytes (PMNs)
This transplant strategy involves initially performing a liver transplant alone, followed by a kidney transplant only if renal function fails to recover.
What is kidney after liver transplant (KALT)?
Despite overall fluid overload, HRS features a decrease in this hemodynamic parameter, which leads to renal vasoconstriction.
What is effective circulating volume?
This volume-related complication of cirrhosis often precedes or accompanies hepatorenal syndrome and requires therapeutic paracentesis.
What is ascites?
Explain the mechanism of action of midodrine and how it treats hepatorenal syndrome?
a1 agonist promotes vasoconstriction of sphlanchic vessels.
This term describes the movement of intestinal bacteria into mesenteric lymph nodes and eventually the peritoneal cavity.
What is bacterial translocation?
This combined transplant is considered when a patient has both irreversible liver failure and chronic kidney disease.
What is simultaneous liver–kidney transplant (SLKT)?
This mechanism causes arterial underfilling and activates RAAS in hepatorenal syndrome
What is splanchnic vasodilation?
In hepatorenal syndrome, this low serum electrolyte is due to ADH-mediated water retention and dilutional effect.
What is hyponatremia?
This treatment is used to counteract effective hypovolemia, increase intravascular volume
What is IV albumin therapy?
Empiric first-line treatment for SBP typically includes this class of antibiotics.
What are third-generation cephalosporins (e.g., cefotaxime)?
Patients who fail to recover kidney function within 60–365 days after a liver transplant may receive this priority status for a kidney transplant.
Safety Net policy
In hepatorenal syndrome, decreased renal perfusion leads to activation of this intrarenal system, which causes vasoconstriction of the afferent arterioles and contributes to reduced GFR.
What is the tubuloglomerular feedback (TGF) system and activation of the RAAS system?
On labs, HRS typically presents with this BUN:creatinine ratio, suggesting prerenal physiology despite underlying liver disease.
What is >20:1?
This radiologic procedure decompresses portal hypertension and may improve renal perfusion in HRS.
transjugular intrahepatic portosystemic shunt)
This condition of the ascitic fluid in cirrhosis lowers opsonic activity and predisposes to bacterial peritonitis
patients with this clinical status receive highest priority for simultaneous liver–kidney transplant. (Think clinical state and GFR level)
Answer: What is dialysis dependence for ≥6 weeks or sustained eGFR <30 mL/min?