Tackle the complex pathophysiology, diagnosis, and management of hepatorenal syndrome in this Curbsiders classic from #NephMadness 2019 featuring
@kidney_boy Joel Topf, HRS expert Juan Carlos Velez (
@veleznephhepato), and self-proclaimed most-handsome-nephrologist Bill Whittier (
@TWhittier_RUSH) episode! Topics: hepatorenal physiology, renal ultrasound, urine electrolytes, terlipressin, norepinephrine, midodrine and octreotide, albumin challenge, crystalloids vs colloids, and more! Original show notes
here.
Credits
- Written and produced by: Justin Berk MD, Nora Taranto MD
- Infographic by: Alex M @nephroguy
- Host: Matthew Watto MD
- Edited by: Matthew Watto MD (audio), Emi Okamoto MD (written materials)
- Guests: Joel Topf MD, Juan Carlos Velez MD, Bill Whittier MD
Show Segments
- NephMadness Kidney Pun Contest
- Disclaimer
- Intro, guest one-liners
- Case of acute kidney injury in a patient with cirrhosis
- Initial differential diagnosis and approach to newly elevated creatinine in cirrhosis (urinalysis, FeNa, urine sodium)
- History and physical in cirrhosis and AKI
- Fluid choice
- Diuretic therapy in cirrhosis and volume overload
- Is a Renal Ultrasound useful in AKI?
- Recap: the initial approach to AKI in cirrhosis
- Therapeutic trials when volume status is uncertain
- Hepatorenal physiology revisited
- Vasoconstrictor therapy with octreotide, terlipressin, or norepinephrine
- Type 1 versus type 2 hepatorenal syndrome
- Large-volume paracentesis (LVP) in cirrhosis with AKI; how much fluid to remove; use of diuretics or LVP in patients on norepinephrine?!
- Diagnostic criteria or HRS
- NephMadness matchups including bile cast nephropathy
- Outro
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