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

Sponsors

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REBOOT #145 Hepatorenal Syndrome