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.
