Hepatorenal syndrome
Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- advanced cirrhosis
- jaundice
- ascites
Outros fatores diagnósticos
- moderate lowering of BP
- peripheral edema
- splenomegaly
- spider angioma
- oliguria
- bruising
- petechiae
- palmar erythema
- scratch marks
- gynecomastia
- encephalopathy
- pruritus
- confusion
- drowsiness
Fatores de risco
- advanced cirrhosis
- ascites
- alcohol-related hepatitis
- hyponatremia
- high plasma renin activity (PRA)
- spontaneous bacterial peritonitis
- large volume paracentesis
- gastrointestinal (GI) bleeding
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- serum creatinine
- BUN
- electrolytes
- CBC
- liver tests
- coagulation study
- diagnostic paracentesis and culture of ascitic fluid
- blood culture
- urinalysis and culture
- Chest x-ray
Investigações a serem consideradas
- renal ultrasound
Algoritmo de tratamento
spontaneous bacterial peritonitis (SBP): prevention of HRS
suspected HRS-AKI
confirmed HRS-AKI
Colaboradores
Autores
Douglas A. Simonetto, MD
Associate Professor of Medicine
Division of Gastroenterology and Hepatology, Department of Medicine
Mayo Clinic
Rochester
MN
Declarações
DAS has done consultancy work for Mallinckrodt, Evive, Resolution Therapeutics, and BioVie. DAS is an author of a reference cited in the topic.
Kathryn A. Schmidt, MD
Division of Gastroenterology and Hepatology, Department of Medicine
Mayo Clinic
Rochester
MN
Declarações
KAS declares that she has no competing interests.
Agradecimentos
Dr Douglas A. Simonetto and Dr Kathryn A. Schmidt would like to gratefully acknowledge Dr John Kepros, the previous contributor to this topic.
Declarações
JK declares that he has no competing interests.
Revisores
William Carey, MD, MACG, FAASLD
Hepatology Section Head
Cleveland Clinic
Cleveland
OH
Declarações
WC declares that he has no competing interests.
Créditos aos pareceristas
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Declarações
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Referências
Principais artigos
Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021 Aug;74(2):1014-48.Texto completo Resumo
Simonetto DA, Gines P, Kamath PS. Hepatorenal syndrome: pathophysiology, diagnosis, and management. BMJ. 2020 Sep 14;370:m2687.Texto completo Resumo
European Association for the Study of the Liver. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018 Aug;69(2):406-60.Texto completo Resumo
European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010 Sep;53(3):397-417.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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