HRS
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Criteria
- Cirrhosis with ascites
- Creatinine > 133 mmol/L
- No improvement in Creatinine after 2 days of diuretic withdrawal and albumin infusion (1g/kg max 100)
- No shock
- No treatment with nephrotoxic drugs
- Absence of parenchymal kidney disease, U/protein < 500mg/day, RBC < 50/HPF, Normal USG
2 types:
Type 1:
- Rapid progression
- Doubling of creatinine to > 222 mmol/L
- 50% reduction of initial 24h creatinine clearance to <20ml/min
- Less than 2 weeks
Type 2:
- Not fulfilling Type 1 criteria
Treatment:
- HD/CVVH, but without liver transplant, prognosis is extremely dismal
- Albumin 20-100g daily
- Terlipressin starting at 0.5mg 4 hourly, uptitrating every 2-3 days depending on the renal function upto a maximum of 12mg (2mg 4 hourly). 52% efficacy in reversing HRS.