Hepatorenal syndrome - Revision history

Ostermayer: Prepared the page for translation

2026-01-04T23:04:44Z

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← Revisión anterior		Revisión del 23:04 4 ene 2026
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	==Background==		==Background==
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	* Arterial vasodilatation in the splanchnic circulation, which is triggered by portal hypertension		* Arterial vasodilatation in the splanchnic circulation, which is triggered by portal hypertension
	*Diagnosis of exclusion		*Diagnosis of exclusion



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	*Type 2		*Type 2
	**Gradual impairment in renal function (that may not advance beyond moderate)		**Gradual impairment in renal function (that may not advance beyond moderate)



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	**Urinary excretion of >500mg protein/d, >50 RBC/hpf, abnormal kidneys on U/S		**Urinary excretion of >500mg protein/d, >50 RBC/hpf, abnormal kidneys on U/S
	*Drug-induced renal failure ([[Special:MyLanguage/NSAIDs\|NSAIDs]], [[Special:MyLanguage/aminoglycosides\|aminoglycosides]])		*Drug-induced renal failure ([[Special:MyLanguage/NSAIDs\|NSAIDs]], [[Special:MyLanguage/aminoglycosides\|aminoglycosides]])



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	**Urine RBC <50 cells/hpf		**Urine RBC <50 cells/hpf
	**Serum sodium <130 mEq/L		**Serum sodium <130 mEq/L



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	**Avoid diuretics and benzodiazepines		**Avoid diuretics and benzodiazepines
	**Discuss giving octreotide and/or midodrine with admitting physician		**Discuss giving octreotide and/or midodrine with admitting physician



Línea 76:		Línea 82:
	*Should be evaluated at liver transplant center		*Should be evaluated at liver transplant center
	*May require TIPS, vasoconstrictors as bridge to transplant		*May require TIPS, vasoconstrictors as bridge to transplant



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	[[Category:GI]]		[[Category:GI]]
	[[Category:Renal]]		[[Category:Renal]]

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Ostermayer: Prepared the page for translation

2026-01-04T23:02:54Z

Prepared the page for translation

← Revisión anterior		Revisión del 23:02 4 ene 2026
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	==Background==		==Background==
	*[[Acute renal failure]] in patient with normal kidneys in presence of acute/chronic hepatic failure
	*Often heralded by the presence of [[SBP]]		*[[Special:MyLanguage/Acute renal failure\|Acute renal failure]] in patient with normal kidneys in presence of acute/chronic hepatic failure
			*Often heralded by the presence of [[Special:MyLanguage/SBP\|SBP]]
	* Arterial vasodilatation in the splanchnic circulation, which is triggered by portal hypertension		* Arterial vasodilatation in the splanchnic circulation, which is triggered by portal hypertension
	*Diagnosis of exclusion		*Diagnosis of exclusion


	==Clinical Features==		==Clinical Features==

	*Type 1		*Type 1
	**Doubling of serum creatinine over a 2-week period		**Doubling of serum creatinine over a 2-week period
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	*Type 2		*Type 2
	**Gradual impairment in renal function (that may not advance beyond moderate)		**Gradual impairment in renal function (that may not advance beyond moderate)


	==Differential Diagnosis==		==Differential Diagnosis==

	*Hypovolemia-induced renal failure		*Hypovolemia-induced renal failure
	**[[GI bleed]]		**[[Special:MyLanguage/GI bleed\|GI bleed]]
	**[[Diuretics]]		**[[Special:MyLanguage/Diuretics\|Diuretics]]
	**[[Diarrhea]]		**[[Special:MyLanguage/Diarrhea\|Diarrhea]]
	*Parenchymal renal disease		*Parenchymal renal disease
	**Urinary excretion of >500mg protein/d, >50 RBC/hpf, abnormal kidneys on U/S		**Urinary excretion of >500mg protein/d, >50 RBC/hpf, abnormal kidneys on U/S
	*Drug-induced renal failure ([[NSAIDs]], [[aminoglycosides]])		*Drug-induced renal failure ([[Special:MyLanguage/NSAIDs\|NSAIDs]], [[Special:MyLanguage/aminoglycosides\|aminoglycosides]])


	==Evaluation<ref>Deepika D et al. Hepatorenal Syndrome Workup. Dec 27, 2015. http://emedicine.medscape.com/article/178208-workup#showall</ref>==		==Evaluation<ref>Deepika D et al. Hepatorenal Syndrome Workup. Dec 27, 2015. http://emedicine.medscape.com/article/178208-workup#showall</ref>==

	*[[Ultrasound: Abdomen\|Abdominal US]]		*[[Ultrasound: Abdomen\|Abdominal US]]
	*Diagnostic [[paracentesis]]		*Diagnostic [[Special:MyLanguage/paracentesis\|paracentesis]]
	*Ascites fluid cultures and analysis		*Ascites fluid cultures and analysis
	*Labs:		*Labs:
	**CBC with diff		**CBC with diff
	**BMP		**BMP
	**[[LFTs]]		**[[Special:MyLanguage/LFTs\|LFTs]]
	**Blood cultures		**Blood cultures
	**[[Urinalysis]]		**[[Special:MyLanguage/Urinalysis\|Urinalysis]]
	**Urine electrolytes and osmolality		**Urine electrolytes and osmolality
	**Consultants: alpha-fetoprotein, cryoglobulins		**Consultants: alpha-fetoprotein, cryoglobulins
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	**Serum creatinine >1.5mg/dL		**Serum creatinine >1.5mg/dL
	**No improvement in renal function after halting diuretics AND admin of 1.5 L of plasma expander		**No improvement in renal function after halting diuretics AND admin of 1.5 L of plasma expander
	**[[Proteinuria]] <500mg/d		**[[Special:MyLanguage/Proteinuria\|Proteinuria]] <500mg/d
	**No [[ultrasound]] evidence of obstructive uropathy or renal parenchymal disease		**No [[Special:MyLanguage/ultrasound\|ultrasound]] evidence of obstructive uropathy or renal parenchymal disease
	**Absence of shock, bacterial infection, hypovolemia, nephrotoxic meds		**Absence of shock, bacterial infection, hypovolemia, nephrotoxic meds
	*Supporting criteria not required for diagnosis:		*Supporting criteria not required for diagnosis:
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	**Urine RBC <50 cells/hpf		**Urine RBC <50 cells/hpf
	**Serum sodium <130 mEq/L		**Serum sodium <130 mEq/L


	==Management==		==Management==
	*[[Vasopressors]]
			*[[Special:MyLanguage/Vasopressors\|Vasopressors]]
	**Terlipressin: 0.5-1mg q 4-6 IV us 5-15d		**Terlipressin: 0.5-1mg q 4-6 IV us 5-15d
	**[[Norepinephrine]]: 0.5-3mg/hr to increase MAP by 10mmHg		**[[Special:MyLanguage/Norepinephrine\|Norepinephrine]]: 0.5-3mg/hr to increase MAP by 10mmHg
	**[[Midodrine]]: 7.5mg PO tid with Octreotide 100mcg sq		**[[Special:MyLanguage/Midodrine\|Midodrine]]: 7.5mg PO tid with Octreotide 100mcg sq
	*Albumin: 1-1.5g/kg with one of above		*Albumin: 1-1.5g/kg with one of above
	*Other:		*Other:
	**[[TIPS]], [[hemodialysis\|renal replacement therapy]]		**[[Special:MyLanguage/TIPS\|TIPS]], [[Special:MyLanguage/hemodialysis\|renal replacement therapy]]
	**Avoid diuretics and benzodiazepines		**Avoid diuretics and benzodiazepines
	**Discuss giving octreotide and/or midodrine with admitting physician		**Discuss giving octreotide and/or midodrine with admitting physician


	==Disposition==		==Disposition==

	*1-month survival: 50%		*1-month survival: 50%
	*6-month survival: 20%		*6-month survival: 20%
	*Should be evaluated at liver transplant center		*Should be evaluated at liver transplant center
	*May require TIPS, vasoconstrictors as bridge to transplant		*May require TIPS, vasoconstrictors as bridge to transplant


	==See Also==		==See Also==


	==References==		==References==

	*NEJM vol 361 no 13 P. Gines		*NEJM vol 361 no 13 P. Gines
	<references/>		<references/>
	[[Category:GI]]		[[Category:GI]]
	[[Category:Renal]]		[[Category:Renal]]
			</translate>

Kxl328: /* Management */

2021-04-24T12:38:13Z

Management

← Revisión anterior		Revisión del 12:38 24 abr 2021
Línea 54:		Línea 54:
	*Other:		*Other:
	**[[TIPS]], [[hemodialysis\|renal replacement therapy]]		**[[TIPS]], [[hemodialysis\|renal replacement therapy]]
	**Avoid diuretics		**Avoid diuretics and benzodiazepines
			**Discuss giving octreotide and/or midodrine with admitting physician

	==Disposition==		==Disposition==

Kxl328: /* Management */

2021-04-24T12:36:24Z

Management

← Revisión anterior		Revisión del 12:36 24 abr 2021
Línea 54:		Línea 54:
	*Other:		*Other:
	**[[TIPS]], [[hemodialysis\|renal replacement therapy]]		**[[TIPS]], [[hemodialysis\|renal replacement therapy]]
			**Avoid diuretics

	==Disposition==		==Disposition==

Blockchainbrown: /* Background */

2021-02-17T23:31:51Z

Background

← Revisión anterior		Revisión del 23:31 17 feb 2021
Línea 2:		Línea 2:
	*[[Acute renal failure]] in patient with normal kidneys in presence of acute/chronic hepatic failure		*[[Acute renal failure]] in patient with normal kidneys in presence of acute/chronic hepatic failure
	*Often heralded by the presence of [[SBP]]		*Often heralded by the presence of [[SBP]]
	*~~Cause~~ is ~~unknown~~		* Arterial vasodilatation in the splanchnic circulation, which is triggered by portal hypertension
	*Diagnosis of exclusion		*Diagnosis of exclusion

Elcatracho: /* Background */

2021-02-03T18:43:50Z

Background

← Revisión anterior		Revisión del 18:43 3 feb 2021
Línea 3:		Línea 3:
	*Often heralded by the presence of [[SBP]]		*Often heralded by the presence of [[SBP]]
	*Cause is unknown		*Cause is unknown
			*Diagnosis of exclusion

	==Clinical Features==		==Clinical Features==

ClaireLewis: /* References */

2019-10-16T17:25:29Z

References

← Revisión anterior		Revisión del 17:25 16 oct 2019
Línea 66:		Línea 66:
	<references/>		<references/>
	[[Category:GI]]		[[Category:GI]]
			[[Category:Renal]]

ClaireLewis: /* EvaluationDeepika D et al. Hepatorenal Syndrome Workup. Dec 27, 2015. http://emedicine.medscape.com/article/178208-workup#showall */

2019-10-16T17:25:02Z

EvaluationDeepika D et al. Hepatorenal Syndrome Workup. Dec 27, 2015. http://emedicine.medscape.com/article/178208-workup#showall

← Revisión anterior		Revisión del 17:25 16 oct 2019
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	**Serum creatinine >1.5mg/dL		**Serum creatinine >1.5mg/dL
	**No improvement in renal function after halting diuretics AND admin of 1.5 L of plasma expander		**No improvement in renal function after halting diuretics AND admin of 1.5 L of plasma expander
	**Proteinuria <500mg/d		**[[Proteinuria]] <500mg/d
	**No [[ultrasound]] evidence of obstructive uropathy or renal parenchymal disease		**No [[ultrasound]] evidence of obstructive uropathy or renal parenchymal disease
	**Absence of shock, bacterial infection, hypovolemia, nephrotoxic meds		**Absence of shock, bacterial infection, hypovolemia, nephrotoxic meds

ClaireLewis: /* Management */

2019-09-30T04:23:55Z

Management

← Revisión anterior		Revisión del 04:23 30 sep 2019
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	*Albumin: 1-1.5g/kg with one of above		*Albumin: 1-1.5g/kg with one of above
	*Other:		*Other:
	**TIPS, renal replacement therapy		**[[TIPS]], [[hemodialysis\|renal replacement therapy]]

	==Disposition==		==Disposition==

ClaireLewis at 21:13, 29 September 2019

2019-09-29T21:13:56Z

← Revisión anterior		Revisión del 21:13 29 sep 2019
Línea 21:		Línea 21:

	==Evaluation<ref>Deepika D et al. Hepatorenal Syndrome Workup. Dec 27, 2015. http://emedicine.medscape.com/article/178208-workup#showall</ref>==		==Evaluation<ref>Deepika D et al. Hepatorenal Syndrome Workup. Dec 27, 2015. http://emedicine.medscape.com/article/178208-workup#showall</ref>==
	*Abdominal US		*[[Ultrasound: Abdomen\|Abdominal US]]
	*Diagnostic paracentesis		*Diagnostic [[paracentesis]]
	*Ascites fluid cultures and analysis		*Ascites fluid cultures and analysis
	*Labs:		*Labs:
	**CBC with diff		**CBC with diff
	**BMP		**BMP
	**LFTs		**[[LFTs]]
	**Blood cultures		**Blood cultures
	**[[Urinalysis]]		**[[Urinalysis]]