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Mar 2022
1h 8m

REBOOT #145 Hepatorenal Syndrome

The Curbsiders Internal Medicine Podcast
About this episode
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.

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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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