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Hepatorenal Syndrome, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Renal failure (RF) in patients with acute or chronic liver disease with no other identifiable cause of renal pathology.

  • Hepatorenal syndrome (HRS) represents significant decline in re...

Diagnosis

Signs and Symptoms

Signs of acute or chronic liver disease: 
  • Signs of portal hypertension

  • Ascites, often tense

  • Progressive oliguria

  • Jaundice or hepatic encephalopathy

  • Coagulopathy

  • Tachycardia

  • Hypote...

Treatment

Pre-Hospital

Attention to ABCs: 
  • Airway control may be a concern in severe encephalopathy.

  • Respiratory failure seen with tense ascites as well as volume overload

  • Correction of hypotension and en...

Follow-Up

Disposition

Admission Criteria

  • All suspected HRS with GI and nephrology consults

  • ICU admission for associated cardiopulmonary disease, hepatic encephalopathy, marked electrolyte imbalances

Discharge Criteria

Pearls and Pitfalls

Any degree of renal dysfunction needs to be evaluated very seriously in patients with liver disease. 

Additional Reading

  • Gines  P, Guevara  M, Arroyo  V, et al. Hepatorenal syndrome. Lancet.  2003;362:1819–1827.

  • Lata,  J. Hepatorenal syndrome. World J Gastroenterol.  2012;18(36):4978–4984.

  • Nad...

Codes

ICD9

  • 572.4 Hepatorenal syndrome

  • 997.49 Other digestive system complications

ICD10

  • K76.7 Hepatorenal syndrome

  • K91.83 Postprocedural hepatorenal syndrome

SNOMED

  • 51292008 Hepatorenal syndrome (disorder)

  • 31...

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