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!
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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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