Summary
Definition
History and exam
Key diagnostic factors
- cirrosis avanzada
- ictericia
- ascitis
Other diagnostic factors
- disminución moderada de la presión arterial
- edema periférico
- esplenomegalia
- angioma aracniforme
- oliguria
- hematomas
- petequias
- eritema palmar
- lesiones de rascado
- ginecomastia
- encefalopatía
- prurito
- confusión
- somnolencia
Risk factors
- cirrosis avanzada
- ascitis
- hepatitis relacionada con el alcohol
- hiponatremia
- elevada actividad de la renina plasmática (ARP)
- peritonitis bacteriana espontánea
- paracentesis de gran volumen
- sangrado gastrointestinal (GI)
Diagnostic tests
1st tests to order
- creatinina sérica
- urea
- electrolitos
- hemograma completo (HC)
- pruebas hepáticas
- estudio de coagulación
- paracentesis diagnóstica y cultivo de líquido ascítico
- hemocultivo
- cultivo y análisis de orina
- Radiografía de tórax
Tests to consider
- ultrasonido renal
Treatment algorithm
peritonitis bacteriana espontánea (PBE): prevención del SHR
sospecha de SHR-DRA
SHR-DRA confirmado
Contributors
Authors
Douglas A. Simonetto, MD
Associate Professor of Medicine
Division of Gastroenterology and Hepatology, Department of Medicine
Mayo Clinic
Rochester
MN
Disclosures
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
Disclosures
KAS declares that she has no competing interests.
Acknowledgements
Dr Douglas A. Simonetto and Dr Kathryn A. Schmidt would like to gratefully acknowledge Dr John Kepros, the previous contributor to this topic.
Disclosures
JK declares that he has no competing interests.
Peer reviewers
William Carey, MD, MACG, FAASLD
Hepatology Section Head
Cleveland Clinic
Cleveland
OH
Disclosures
WC declares that he has no competing interests.
References
Key articles
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.Full text Abstract
Simonetto DA, Gines P, Kamath PS. Hepatorenal syndrome: pathophysiology, diagnosis, and management. BMJ. 2020 Sep 14;370:m2687.Full text Abstract
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.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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