Hepatorenal Syndrome Questions & Answers

Updated: Oct 16, 2017
  • Author: Deepika Devuni, MD; Chief Editor: BS Anand, MD  more...
  • Print
Questions & Answers

Overview

What is hepatorenal syndrome (HRS)?

What is the historical background on hepatorenal syndrome (HRS)?

What is the histologic appearance of the kidneys in hepatorenal syndrome (HRS)?

What are relevant studies in hepatorenal syndrome (HRS)?

How is acute kidney injury (AKI) classified in hepatorenal syndrome (HRS)?

What is the hallmark of hepatorenal syndrome (HRS) and how is it characterized?

Which systems are responsible for renal vasoconstriction in hepatorenal syndrome (HRS)?

What is the role of nitric oxide (NO) in the pathophysiology of hepatorenal syndrome (HRS)?

Why does hepatorenal syndrome (HRS) develop in patients with in cirrhosis?

What are the risk factors for developing hepatorenal syndrome (HRS)?

Which conditions precipitate hepatorenal syndrome (HRS)?

What are the risk factors associated with the development of hepatorenal syndrome (HRS) in patients with cirrhosis who are nonazotemic?

What is the incidence of hepatorenal syndrome (HRS) in the US?

What is the global incidence of hepatorenal syndrome (HRS)?

What are the race-related demographics of hepatorenal syndrome (HRS)?

What are the sex- and age-related demographics of hepatorenal syndrome (HRS)?

What is the prognosis of hepatorenal syndrome (HRS)?

How is the mortality and morbidity of hepatorenal syndrome (HRS) characterized?

What is the prognosis of hepatorenal syndrome (HRS)?

What do patients who have cirrhosis with ascites need to know about hepatorenal syndrome (HRS)?

Presentation

What is the clinical history of hepatorenal syndrome?

What are the physical findings of the hands in hepatorenal syndrome (HRS)?

What are the physical findings of the head, ears, nose, and throat in hepatorenal syndrome (HRS)?

What are the physical findings of the chest and abdomen in hepatorenal syndrome (HRS)?

What are the physical findings of the genitalia in hepatorenal syndrome (HRS)?

What are the physical findings of the extremities in hepatorenal syndrome (HRS)?

DDX

What are the diagnostic considerations of hepatorenal syndrome (HRS)?

What are the differential diagnoses for Hepatorenal Syndrome?

Workup

Which studies are indicated in the workup of hepatorenal syndrome (HRS)?

How is hepatorenal syndrome (HRS) diagnosed?

What is the role of a CBC with differential in the workup of hepatorenal syndrome (HRS)?

When are serum electrolytes and renal function studies indicated in the workup of hepatorenal syndrome (HRS)?

When are liver function tests with prothrombin time indicated in the workup of hepatorenal syndrome (HRS)?

When is an alpha-fetoprotein measurement indicated in the workup of hepatorenal syndrome (HRS)?

When are blood cultures indicated in the workup of hepatorenal syndrome?

When is a cryoglobulin study indicated in the workup of hepatorenal syndrome (HRS)?

When are urinalysis and urine electrolytes studies indicated in the workup of hepatorenal syndrome (HRS)?

When is abdominal ultrasonography indicated in the workup of hepatorenal syndrome (HRS)?

When is an echocardiogram indicated in the workup of hepatorenal syndrome (HRS)?

When is paracentesis indicated in the workup of hepatorenal syndrome (HRS)?

When is bladder catheterization indicated in the workup of hepatorenal syndrome (HRS)?

When are central line and Swan-Ganz line placement indicated in the workup of hepatorenal syndrome (HRS)?

What are the histologic findings of the kidneys in hepatorenal syndrome (HRS)?

Treatment

What are the approach considerations in the treatment of hepatorenal syndrome (HRS)?

When should patients with hepatorenal syndrome (HRS) be transferred to a liver transplant center?

What is the recommended antibiotic of choice for spontaneous bacterial peritonitis (SBP) in hepatorenal syndrome (HRS)?

What is the ideal treatment of hepatorenal syndrome (HRS)?

Which medications are used for the treatment of hepatorenal syndrome (HRS)?

Is dopamine effective for the treatment of hepatorenal syndrome (HRS)?

Is misoprostol effective for the treatment of hepatorenal syndrome (HRS)?

Are renal vasoconstrictor antagonists effective for the treatment of hepatorenal syndrome (HRS)?

Are synthetic vasoconstrictors effective for the treatment of hepatorenal syndrome (HRS)?

Are combination synthetic vasoconstrictors effective for the treatment of hepatorenal syndrome (HRS)?

Do vasoconstrictor drugs reduce mortality in patients with type 1 or type 2 hepatorenal syndrome (HRS)?

Is terlipressin plus albumin or midodrine and octreotide plus albumin effective in the treatment of hepatorenal syndrome (HRS)?

What can be concluded from studies regarding systemic vasoconstrictors for the treatment of hepatorenal syndrome?

What are the dietary considerations in the treatment of hepatorenal syndrome (HRS)?

How effective is liver transplantation for the treatment of hepatorenal syndrome (HRS)?

What is the role of peritoneovenous shunting (PVS) in the treatment of hepatorenal syndrome (HRS)?

What is the role of surgical shunts in the treatment of hepatorenal syndrome (HRS)?

What are the postoperative considerations in liver transplantation for hepatorenal syndrome (HRS)?

What is the role of a nephrologist in the treatment of hepatorenal syndrome (HRS)?

What is the role of dialysis in the treatment of hepatorenal syndrome (HRS)?

What is the efficacy of continuous arteriovenous or venovenous hemofiltration in the treatment of hepatorenal syndrome (HRS)?

What is the role of the molecular adsorbent recirculating system (MARS) in the treatment of hepatorenal syndrome (HRS)?

What is the role of a transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of hepatorenal syndrome (HRS)?

What is the main precipitating factor in type 1 hepatorenal syndrome (HRS) and how can it be prevented?

What is the relationship between large-volume paracentesis (LVP) and hepatorenal syndrome (HRS)?

What is the role of pentoxifylline in the prevention of hepatorenal syndrome (HRS)?

Medications

What is the pharmacological approach to the treatment of hepatorenal syndrome (HRS)?

Which medications in the drug class Plasma volume expanders are used in the treatment of Hepatorenal Syndrome?

Which medications in the drug class Antibiotics are used in the treatment of Hepatorenal Syndrome?

Which medications in the drug class Antioxidants are used in the treatment of Hepatorenal Syndrome?

Which medications in the drug class Somatostatin analogs are used in the treatment of Hepatorenal Syndrome?

Which medications in the drug class Sympathomimetic agents are used in the treatment of Hepatorenal Syndrome?

Which medications in the drug class Vasopressin analogues are used in the treatment of Hepatorenal Syndrome?