Hepatorenal syndrome differential diagnosis: Difference between revisions
Jump to navigation
Jump to search
Sunny Kumar (talk | contribs) |
Ahmed Younes (talk | contribs) No edit summary |
||
| (4 intermediate revisions by one other user not shown) | |||
| Line 1: | Line 1: | ||
__NOTOC__ | __NOTOC__ | ||
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Hepatorenal_syndrome]] | |||
{{CMG}}; {{AE}}{{SKA}} | {{CMG}}; {{AE}}{{SKA}} | ||
==Overview== | ==Overview== | ||
Many other diseases of the kidney are associated with liver disease and must be excluded before making a diagnosis of hepatorenal syndrome. | Many other diseases of the [[kidney]] are associated with [[liver]] disease and must be excluded before making a diagnosis of hepatorenal syndrome. | ||
==Differentiating Hepatorenal Syndrome from other Diseases== | ==Differentiating Hepatorenal Syndrome from other Diseases== | ||
Many other diseases of the kidney are associated with liver disease and must be excluded before making a diagnosis of hepatorenal syndrome. | Many other diseases of the [[kidney]] are associated with [[Liver diseases|liver disease]] and must be excluded before making a diagnosis of hepatorenal syndrome. They include the following:<ref name="pmid17389705">{{cite journal |vauthors=Salerno F, Gerbes A, Ginès P, Wong F, Arroyo V |title=Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis |journal=Gut |volume=56 |issue=9 |pages=1310–8 |year=2007 |pmid=17389705 |pmc=1954971 |doi=10.1136/gut.2006.107789 |url=}}</ref><ref name="pmid20682324">{{cite journal |vauthors=Martín-Llahí M, Guevara M, Torre A, Fagundes C, Restuccia T, Gilabert R, Solá E, Pereira G, Marinelli M, Pavesi M, Fernández J, Rodés J, Arroyo V, Ginès P |title=Prognostic importance of the cause of renal failure in patients with cirrhosis |journal=Gastroenterology |volume=140 |issue=2 |pages=488–496.e4 |year=2011 |pmid=20682324 |doi=10.1053/j.gastro.2010.07.043 |url=}}</ref><ref name="pmid22562534">{{cite journal |vauthors=Verna EC, Brown RS, Farrand E, Pichardo EM, Forster CS, Sola-Del Valle DA, Adkins SH, Sise ME, Oliver JA, Radhakrishnan J, Barasch JM, Nickolas TL |title=Urinary neutrophil gelatinase-associated lipocalin predicts mortality and identifies acute kidney injury in cirrhosis |journal=Dig. Dis. Sci. |volume=57 |issue=9 |pages=2362–70 |year=2012 |pmid=22562534 |pmc=3979299 |doi=10.1007/s10620-012-2180-x |url=}}</ref><ref name="pmid19776409">{{cite journal |vauthors=Ginès P, Schrier RW |title=Renal failure in cirrhosis |journal=N. Engl. J. Med. |volume=361 |issue=13 |pages=1279–90 |year=2009 |pmid=19776409 |doi=10.1056/NEJMra0809139 |url=}}</ref><ref name="pmid8550036">{{cite journal |vauthors=Arroyo V, Ginès P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, Reynolds TB, Ring-Larsen H, Schölmerich J |title=Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club |journal=Hepatology |volume=23 |issue=1 |pages=164–76 |year=1996 |pmid=8550036 |doi=10.1002/hep.510230122 |url=}}</ref> | ||
{| class="wikitable" | {| class="wikitable" | ||
!Variables | !Variables | ||
!Kidney injury associated with infection | ![[Kidney]] injury associated with infection | ||
!Prerenal acute kidney | !Prerenal [[Acute kidney injury|acute kidney injur]]<nowiki/>y | ||
!Hepatorenal syndrome | !Hepatorenal syndrome | ||
!Parenchymal renal disease | !Parenchymal renal disease | ||
| Line 17: | Line 17: | ||
|Mechanism | |Mechanism | ||
Causes | Causes | ||
|Infections including SBP | |[[Infection|Infections]], including SBP | ||
|Hypovolumia due: | |Hypovolumia due: | ||
gastrointestinal fluid losses | gastrointestinal fluid losses | ||
| Line 25: | Line 25: | ||
diuretic | diuretic | ||
[[non-steroidal anti-inflammatory drug]] | |||
|Splanic vasodalation due to | |Splanic vasodalation due to nitic oxide | ||
|Aminoglycoside therapy | |[[Aminoglycoside]] therapy | ||
Radiocontrast agent | [[Radiocontrast|Radiocontrast agent]] | ||
Sepsis | Sepsis | ||
| Line 34: | Line 34: | ||
|Diagnostic clue | |Diagnostic clue | ||
|History of fever | |History of fever | ||
Blood cultures | [[Blood culture|Blood cultures]] | ||
Ascetic cultures | Ascetic cultures | ||
| Line 40: | Line 40: | ||
Bleeding | Bleeding | ||
Low [[blood pressure]] | |||
Intake of | Intake of [[Non-steroidal anti-inflammatory drug|NSAID]] | ||
|Diagnosis of exclusion: | |Diagnosis of exclusion: | ||
Liver failure + Renal failure | Liver failure + Renal failure | ||
| Line 54: | Line 54: | ||
repleating fluid loss | repleating fluid loss | ||
|History of: | |History of: | ||
Infections | [[Infection|Infections]] | ||
Injection of Dye | Injection of [[Dye]] | ||
intake of nephrotoxic agent | intake of nephrotoxic agent | ||
Latest revision as of 21:55, 8 February 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sunny Kumar MD [2]
Overview
Many other diseases of the kidney are associated with liver disease and must be excluded before making a diagnosis of hepatorenal syndrome.
Differentiating Hepatorenal Syndrome from other Diseases
Many other diseases of the kidney are associated with liver disease and must be excluded before making a diagnosis of hepatorenal syndrome. They include the following:[1][2][3][4][5]
| Variables | Kidney injury associated with infection | Prerenal acute kidney injury | Hepatorenal syndrome | Parenchymal renal disease |
|---|---|---|---|---|
| Mechanism
Causes |
Infections, including SBP | Hypovolumia due:
gastrointestinal fluid losses bleeding diuretic |
Splanic vasodalation due to nitic oxide | Aminoglycoside therapy
Sepsis |
| Diagnostic clue | History of fever
Ascetic cultures |
History of:
Bleeding Low blood pressure Intake of NSAID |
Diagnosis of exclusion:
Liver failure + Renal failure no apparent cause for the acute kidney injury No improvement on removing nephrotoxic agent repleating fluid loss |
History of:
Injection of Dye intake of nephrotoxic agent |
| Prognosis | Good | Good | Poor | Good |
References
- ↑ Salerno F, Gerbes A, Ginès P, Wong F, Arroyo V (2007). "Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis". Gut. 56 (9): 1310–8. doi:10.1136/gut.2006.107789. PMC 1954971. PMID 17389705.
- ↑ Martín-Llahí M, Guevara M, Torre A, Fagundes C, Restuccia T, Gilabert R, Solá E, Pereira G, Marinelli M, Pavesi M, Fernández J, Rodés J, Arroyo V, Ginès P (2011). "Prognostic importance of the cause of renal failure in patients with cirrhosis". Gastroenterology. 140 (2): 488–496.e4. doi:10.1053/j.gastro.2010.07.043. PMID 20682324.
- ↑ Verna EC, Brown RS, Farrand E, Pichardo EM, Forster CS, Sola-Del Valle DA, Adkins SH, Sise ME, Oliver JA, Radhakrishnan J, Barasch JM, Nickolas TL (2012). "Urinary neutrophil gelatinase-associated lipocalin predicts mortality and identifies acute kidney injury in cirrhosis". Dig. Dis. Sci. 57 (9): 2362–70. doi:10.1007/s10620-012-2180-x. PMC 3979299. PMID 22562534.
- ↑ Ginès P, Schrier RW (2009). "Renal failure in cirrhosis". N. Engl. J. Med. 361 (13): 1279–90. doi:10.1056/NEJMra0809139. PMID 19776409.
- ↑ Arroyo V, Ginès P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, Reynolds TB, Ring-Larsen H, Schölmerich J (1996). "Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club". Hepatology. 23 (1): 164–76. doi:10.1002/hep.510230122. PMID 8550036.