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Hepato-Renal Syndrome
- Hepato-renal syndrome (HRS) is the development of acute kidney injury (AKI) in patients with advanced cirrhosis.
- HRS is traditionally divided into two types based upon how quickly AKI develops:
- Type I: a rapid decline in function in less than 2 weeks
- Type II: a slow decline in function over weeks to months
- Type I is more likely to be seen in the ED and is often due to a precipitating event such as:
- GI bleed
- Spontaneous bacterial peritonitis (SBP)
- Hypovolemia from aggressive diuresis
- In ED patients with advanced cirrhosis and new, or worsening, AKI think about HRS.
- If suspected, look for precipitants (i.e. SBP), restore volume with IVFs, avoid nephrotoxins (IV contrast), and administer vasopressor therapy when indicated.
References
Bagshaw SM, Bellomo R, Devarajan P, et al. Review article: Acute kidney injury in critical illness. Can J Anesth 2010; 57:985-998.