IBCC Episode 116 - Hepatorenal Syndrome

In this episode of The Internet Book of Critical Care Podcast, Josh and Adam discuss hepatorenal syndrome, focusing on its physiology, nomenclature (HRS-1, HRS-2, HRS-AKI, HRS-CKD), workup, and treatment. They delve into the systemic vasodilation characteristic of cirrhosis and how it leads to renal vasoconstriction, eventually causing acute tubular necrosis if untreated. The discussion covers prevention strategies, epidemiology, clinical presentation (substrate, precipitating factors, and kidney injury), differential diagnosis, and a streamlined approach to diagnosis and treatment. They emphasize the importance of early, aggressive intervention with vasoconstrictors like norepinephrine and albumin, while also considering the role of diuretics, paracentesis, adrenal support, and when to consider hemodialysis and liver transplantation.