Hepatorenal syndrome

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Risk factors

Advanced cirrhosis, portal hypertension and edema

Pathophysiology

NO in the splanchnic circulation secondary to portal hypertension systemic vasodilation RAAS activation, ADH

Precipitating factors

  • Reduced renal perfusion (GI bleed, vomiting, sepsis, excessive diuretics)
  • NSAIDS

Diagnosis

  • Renal hypoperfusion (FeNa < 1% or UNa < 10)
  • No tubular injury (no casts)
  • No improvement with fluids

Treatment

  • Address hypovolemia, anemia or infection
  • Splanchnic vasoconstrictors (octreotide, norepinephrine, midodrine)
  • Transplant