The Curbsiders Internal Medicine Podcast

#145 NephMadness: Hepatorenal Syndrome vs AKI

March 25, 2019
80 min

Does your sympathetic nervous system get activated when you notice acute kidney injury in patients with cirrhosis? Ever wonder how to really diagnose hepatorenal syndrome (HRS)? Think you have the bile-acid-stones to start diuretics on a patient requiring pressor support for kidney failure? You have come to the right place! Listen to @kidney_boy Joel Topf, HRS expert Juan Carlos Velez (@veleznephhepato), and self-proclaimed most-handsome-nephrologist Bill Whittier (@TWhittier_RUSH) tackle the complex pathophysiology and treatment of hepatorenal syndrome in this NephMadness 2019 special episode!

Fill out your bracket for NephMadness 2019 today and sign up as part of The Curbsiders! Earn CME and read about each region at AJKD blog.

Full show notes available at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Justin Berk MD, Nora Taranto MS4

Infographic by: Alex M @nephroguy

Hosts: Matthew Watto MD

Edited by: Matthew Watto MD, Emi Okamoto MD

Guests: Joel Topf MD, Juan Carlos Velez MD, Bill Whittier MD

Sponsor

Get your ACP membership today and use the code CURB100 to save $100 when you join by March 31, 2019.

Time Stamps

  • 00:00 NephMadness Kidney Pun Contest
  • 01:04 Disclaimer
  • 01:38 Sponsor - Become an ACP member today!
  • 02:12 Intro, guest bio
  • 04:38 Guest one-liners, some career advice and Joel’s pick of the week
  • 13:14 Sponsor - Become an ACP member today!
  • 14:48 Case of acute kidney injury in a patient with cirrhosis
  • 16:37 Initial differential diagnosis and approach to newly elevated creatinine in cirrhosis (urinalysis, FeNa, urine sodium)
  • 21:34 History and physical in cirrhosis and AKI
  • 24:56 Hepatorenal physiology
  • 26:45 Fluid choice
  • 30:27 Diuretic therapy in cirrhosis and volume overload
  • 34:38 Is a Renal Ultrasound useful in AKI?
  • 40:05 Recap: the initial approach to AKI in cirrhosis
  • 40:52 Therapeutic trials when volume status is uncertain
  • 46:02 Hepatorenal physiology revisited
  • 50:03 Vasoconstrictor therapy with octreotide, terlipressin, or norepinephrine
  • 62:24 Type 1 versus type 2 hepatorenal syndrome
  • 63:55 Large volume paracentesis (LVP) in cirrhosis with AKI; how much fluid to remove; use of diuretics or LVP in patient on norepinephrine?!
  • 71:18 Diagnostic criteria or HRS
  • 73:00 NephMadness matchups including bile cast nephropathy
  • 78:40 Outro

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