Hypokalemia and metabolic alkalosis are considered precipitating factors for hepatic encephalopathy, as hypokalemia stimulates ammoniagenesis in the proximal tubule. Although, the mechanism is not entirely clear, the likely hypothesis is as follows: *Hypokalemia causes the movement of potassium…
Hepatorenal syndrome (HRS) is a frequent consult encountered on the nephrology service. The criteria have recently been revised. Conall reviewed the revised criteria on a prior post last year. To review the pathophysiology of HRS click here. In…
Spironolactone has long been favored in the setting of decompensated liver disease; the effective control of “secondary aldosteronism” is usually given as the reason for this in textbooks. However, this is like saying you should open a new…
They may have struggled to get girlfriends in college, but members of the International Ascites Club do call the shots when it comes to defining hepato-renal syndrome (HRS). As they were published in Gut, their revised criteria for…
One of the major medical advances over the past few decades has been the success of stem cell transplants, which serves as a potential cure for many patients with previously untreatable leukemias and lymphomas. With the expanded use…
There are only limited treatment options for hepatorenal syndrome, and many would argue that treatment of type I hepatorenal syndrome (the bad kind) in the absence of a plan for liver transplantation is a futile effort. Over the…
An unusual cause of ascites is urinary ascites: this occurs when there is rupture of either the ureter or bladder, leading to leakage of urine into the peritoneal space. In adults, this is almost always due to either…
Amongst the given differential diagnosis for acute renal failure in liver disease is an entity termed “cholemic nephrosis.” It is debatable as to whether or not this actually exists or represents part of the spectrum of hepatorenal syndrome…
Hepatorenal syndrome (HRS) is thought to be caused by splanchnic vasodilatation with relative renal vasoconstriction. The reversible nature of HRS is highlighted by the observation that patients with HRS who undergo liver transplant usually see a complete reversal…
Hepatorenal syndrome is a very common consult topic for the 1st year renal fellow. All MDs trained in internal medicine realize that cirrhotic patients are amongst the sickest in the hospital, and one of the reasons for this…
