Annals for Hospitalists Inpatient Notes - Clinical Pearls—Hepatorenal Syndrome
Authors: Elliot B. Tapper, Jaume Bosch
Journal: Annals of Internal Medicine (2021)

Web ExclusivesJuly 2021Annals for Hospitalists Inpatient Notes - Clinical Pearls—Hepatorenal SyndromeElliot B. Tapper, MD and Jaume Bosch, MDElliot B. Tapper, MDUniversity of Michigan, Ann Arbor, Michigan (E.B.T.)Search for more papers by this author and Jaume Bosch, MDUniversity of Bern, Bern, and University Clinic for Visceral Medicine and Surgery, Inselspital, Switzerland (J.B.).Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-2289 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail A 38-year-old woman with alcohol-related cirrhosis complicated by ascites presented with increasing confusion and falls over 3 days. On examination, her temperature was 37.8 °C, heart rate was 120 beats/min, and blood pressure was 99/54 mm Hg. She had a distended abdomen with a fluid wave. She was lethargic and had asterixis. Laboratory results were notable for total bilirubin level of 172.75 μmol/L (10.1 mg/dL) (baseline, 140.25 μmol/L [8.2 mg/dL]), creatinine level of 79.56 μmol/L (0.9 mg/dL) (baseline, 35.36 μmol/L [0.4 mg/dL]), sodium level of 129 mmol/L (baseline, 136 mmol/L), undetectable urine sodium level, and an international normalized ratio (INR) ...References1. Tapper EB, Bonder A, Cardenas A. Preventing and treating acute kidney injury among hospitalized patients with cirrhosis and ascites: a narrative review. Am J Med. 2016;129:461-7. [PMID: 26724589] doi:10.1016/j.amjmed.2015.12.006 CrossrefMedlineGoogle Scholar2. Thomson MJ, Taylor A, Sharma P, et al. Limited progress in hepatorenal syndrome (HRS) reversal and survival 2002-2018: a systematic review and meta-analysis. Dig Dis Sci. 2020;65:1539-1548. [PMID: 31571102] doi:10.1007/s10620-019-05858-2 CrossrefMedlineGoogle Scholar3. Angeli P, Gines P, Wong F, et al; International Club of Ascites. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. Gut. 2015;64:531-7. [PMID: 25631669] doi:10.1136/gutjnl-2014-308874 CrossrefMedlineGoogle Scholar4. Velez JC, Kadian M, Taburyanskaya M, et al. Hepatorenal acute kidney injury and the importance of raising mean arterial pressure. Nephron. 2015;131:191-201. [PMID: 26485256] doi:10.1159/000441151 CrossrefMedlineGoogle Scholar5. Wong F, Pappas SC, Curry MP, et al; CONFIRM Study Investigators. Terlipressin plus albumin for the treatment of type 1 hepatorenal syndrome. N Engl J Med. 2021;384:818-828. [PMID: 33657294] doi:10.1056/NEJMoa2008290 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Michigan, Ann Arbor, Michigan (E.B.T.)University of Bern, Bern, and University Clinic for Visceral Medicine and Surgery, Inselspital, Switzerland (J.B.).Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-2289.Corresponding Author: Elliot Tapper, MD, 1500 East Medical Center Drive, Ann Arbor, MI 48109; e-mail, [email protected]edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists - July 2021 David H. Wesorick , Jawad Al-Khafaji , and Matthew Luzum Metrics July 2021Volume 174, Issue 7Page: HO2-HO3KeywordsAcute kidney injuryAscitesCirrhosisGastroenterology and hepatologyHepatorenal syndromeSpontaneous bacterial peritonitisVasopressors ePublished: 20 July 2021 Issue Published: July 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...