Does your sympathetic nervous system get activated when you notice acute kidney injury in patients with cirrhosis? Ever wonder how to really diagnose hepatorenal syndrome (HRS)? Think you have the bile-acid-stones to start diuretics on a patient requiring pressor support for kidney failure? You have come to the right place! Listen to @kidney_boy Joel Topf, HRS expert Juan Carlos Velez (@veleznephhepato), and self-proclaimed most-handsome-nephrologist Bill Whittier (@TWhittier_RUSH) tackle the complex pathophysiology and treatment of hepatorenal syndrome in this NephMadness 2019 special episode!
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Written and produced by: Justin Berk MD, Nora Taranto MS4
Infographic by: Alex M @nephroguy
Hosts: Matthew Watto MD
Edited by: Matthew Watto MD, Emi Okamoto MD
Guests: Joel Topf MD, Juan Carlos Velez MD, Bill Whittier MD
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- 00:00 NephMadness Kidney Pun Contest
- 01:04 Disclaimer
- 01:38 Sponsor - Become an ACP member today!
- 02:12 Intro, guest bio
- 04:38 Guest one-liners, some career advice and Joel’s pick of the week
- 13:14 Sponsor - Become an ACP member today!
- 14:48 Case of acute kidney injury in a patient with cirrhosis
- 16:37 Initial differential diagnosis and approach to newly elevated creatinine in cirrhosis (urinalysis, FeNa, urine sodium)
- 21:34 History and physical in cirrhosis and AKI
- 24:56 Hepatorenal physiology
- 26:45 Fluid choice
- 30:27 Diuretic therapy in cirrhosis and volume overload
- 34:38 Is a Renal Ultrasound useful in AKI?
- 40:05 Recap: the initial approach to AKI in cirrhosis
- 40:52 Therapeutic trials when volume status is uncertain
- 46:02 Hepatorenal physiology revisited
- 50:03 Vasoconstrictor therapy with octreotide, terlipressin, or norepinephrine
- 62:24 Type 1 versus type 2 hepatorenal syndrome
- 63:55 Large volume paracentesis (LVP) in cirrhosis with AKI; how much fluid to remove; use of diuretics or LVP in patient on norepinephrine?!
- 71:18 Diagnostic criteria or HRS
- 73:00 NephMadness matchups including bile cast nephropathy
- 78:40 Outro