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Inhoud geleverd door Sean P. Kane, PharmD, BCPS, Sean P. Kane, and PharmD; Khyati Patel. Alle podcastinhoud, inclusief afleveringen, afbeeldingen en podcastbeschrijvingen, wordt rechtstreeks geüpload en geleverd door Sean P. Kane, PharmD, BCPS, Sean P. Kane, and PharmD; Khyati Patel of hun podcastplatformpartner. Als u denkt dat iemand uw auteursrechtelijk beschermde werk zonder uw toestemming gebruikt, kunt u het hier beschreven proces https://nl.player.fm/legal volgen.
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141 - What You Need to Know about Hepatorenal Syndrome: New Definitions, Treatments, and Clinical Pearls

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Manage episode 315945369 series 70056
Inhoud geleverd door Sean P. Kane, PharmD, BCPS, Sean P. Kane, and PharmD; Khyati Patel. Alle podcastinhoud, inclusief afleveringen, afbeeldingen en podcastbeschrijvingen, wordt rechtstreeks geüpload en geleverd door Sean P. Kane, PharmD, BCPS, Sean P. Kane, and PharmD; Khyati Patel of hun podcastplatformpartner. Als u denkt dat iemand uw auteursrechtelijk beschermde werk zonder uw toestemming gebruikt, kunt u het hier beschreven proces https://nl.player.fm/legal volgen.

In this episode, we provide a concise overview of the diagnosis and treatment of hepatorenal syndrome-acute kidney injury (HRS-AKI) with a focus on the new HRS-1 definition (now called HRS-AKI), new data with terlipressin, and the AASLD 2021 guidelines.

Key Concepts

  1. At a basic level, HRS-AKI is caused by portal hypertension leading to systemic vasodilation and a prerenal state. Our treatment focuses on increasing vascular volume (usually with albumin) and vasoconstriction to increase renal perfusion.
  2. The newest HRS-AKI definition borrows most of the AKI definitions from the KDIGO criteria for AKI. HRS-AKI requires cirrhosis, ascites, AKI, and an exclusion of other etiologies of AKI.
  3. In AKI and HRS-AKI, concentrated (25%) albumin is given. A dose of 1 gm/kg/day (max 100 gm) for two days is used for AKI. For HRS-AKI, a dose of 20-50 grams/day is recommended.
  4. The preferred vasoconstrictor in HRS-AKI is terlipressin; however, it is not available in the US. Norepinephrine (if in the ICU) is second-line. If not in the ICU, midodrine and octreotide are recommended. Therapy is continued until renal function recovers, if there is no improvement at 4 days, or if a full 14 days of therapy has been given.

References

  1. Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74(2):1014-1048. doi:10.1002/hep.31884
  2. European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406-460. doi:10.1016/j.jhep.2018.03.024
  continue reading

194 afleveringen

Artwork
iconDelen
 
Manage episode 315945369 series 70056
Inhoud geleverd door Sean P. Kane, PharmD, BCPS, Sean P. Kane, and PharmD; Khyati Patel. Alle podcastinhoud, inclusief afleveringen, afbeeldingen en podcastbeschrijvingen, wordt rechtstreeks geüpload en geleverd door Sean P. Kane, PharmD, BCPS, Sean P. Kane, and PharmD; Khyati Patel of hun podcastplatformpartner. Als u denkt dat iemand uw auteursrechtelijk beschermde werk zonder uw toestemming gebruikt, kunt u het hier beschreven proces https://nl.player.fm/legal volgen.

In this episode, we provide a concise overview of the diagnosis and treatment of hepatorenal syndrome-acute kidney injury (HRS-AKI) with a focus on the new HRS-1 definition (now called HRS-AKI), new data with terlipressin, and the AASLD 2021 guidelines.

Key Concepts

  1. At a basic level, HRS-AKI is caused by portal hypertension leading to systemic vasodilation and a prerenal state. Our treatment focuses on increasing vascular volume (usually with albumin) and vasoconstriction to increase renal perfusion.
  2. The newest HRS-AKI definition borrows most of the AKI definitions from the KDIGO criteria for AKI. HRS-AKI requires cirrhosis, ascites, AKI, and an exclusion of other etiologies of AKI.
  3. In AKI and HRS-AKI, concentrated (25%) albumin is given. A dose of 1 gm/kg/day (max 100 gm) for two days is used for AKI. For HRS-AKI, a dose of 20-50 grams/day is recommended.
  4. The preferred vasoconstrictor in HRS-AKI is terlipressin; however, it is not available in the US. Norepinephrine (if in the ICU) is second-line. If not in the ICU, midodrine and octreotide are recommended. Therapy is continued until renal function recovers, if there is no improvement at 4 days, or if a full 14 days of therapy has been given.

References

  1. Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74(2):1014-1048. doi:10.1002/hep.31884
  2. European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406-460. doi:10.1016/j.jhep.2018.03.024
  continue reading

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