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REBOOT #145 Hepatorenal Syndrome

Author
The Curbsiders Internal Medicine Podcast
Published
Mon 28 Mar 2022
Episode Link
https://audioboom.com/posts/8054536

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




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