UMEM Educational Pearls

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.