Hepatorenal syndrome classification: Difference between revisions
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==Overview== | ==Overview== | ||
The classification of | The classification of hepatorenal syndrome is based on the deteriorating function of [[kidney]] in to two types: type 1 rapidly progressive and type 2 HRS, slowly progressive. | ||
==Classification== | ==Classification== | ||
The hepatorenal syndrome is defined as renal failure that occurs in the setting of liver disease as follows: | The hepatorenal syndrome is defined as [[Renal insufficiency|renal failure]] that occurs in the setting of liver disease as follows: | ||
===Type I HRS=== | ===Type I HRS=== | ||
'''Type I HRS''' is characterized by rapidly progressive renal failure with a doubling of serum [[creatinine]] to a level greater than 221 [[Mole (unit)|μmol]]/L (2.5 [[milligram|mg]]/[[decilitre|dL]]) or a halving of the [[creatinine clearance]] to less than 20 mL/min over a period of less than 2 weeks. | '''Type I HRS''' is characterized by rapidly progressive [[Renal insufficiency|renal failure]] with a doubling of serum [[creatinine]] to a level greater than 221 [[Mole (unit)|μmol]]/L (2.5 [[milligram|mg]]/[[decilitre|dL]]) or a halving of the [[creatinine clearance]] to less than 20 mL/min over a period of less than 2 weeks. | ||
===Type II HRS=== | ===Type II HRS=== | ||
'''Type II HRS''' is characterized by a slowly progressive: | '''Type II HRS''' is characterized by a slowly progressive: | ||
* Increase in serum [[creatinine]] level to greater than 133 μmol/L (1.5 mg/dL) or a creatinine clearance of less than 40 mL/min | * Increase in serum [[creatinine]] level to greater than 133 μmol/L (1.5 mg/dL) or a creatinine clearance of less than 40 mL/min. | ||
* Urine sodium < 10 meq/dl<ref name="pmid3297907">{{cite journal |author=Ginés P, Arroyo V, Quintero E, ''et al'' |title=Comparison of paracentesis and diuretics in the treatment of cirrhotics with tense ascites. Results of a randomized study |journal=Gastroenterology |volume=93 |issue=2 |pages=234-41 |year=1987 |pmid=3297907 |doi=}}</ref> | * Urine sodium < 10 meq/dl. <ref name="pmid3297907">{{cite journal |author=Ginés P, Arroyo V, Quintero E, ''et al'' |title=Comparison of paracentesis and diuretics in the treatment of cirrhotics with tense ascites. Results of a randomized study |journal=Gastroenterology |volume=93 |issue=2 |pages=234-41 |year=1987 |pmid=3297907 |doi=}}</ref> | ||
==== Classification on basis of mechanism of kidney injury in presence of liver failure: ==== | ==== Classification on basis of mechanism of kidney injury in presence of liver failure: ==== | ||
# '''Hypovoluemia induced kidney injury:''' It occurs due to loss of fluid through GIT or GI bleed in presence of liver failure which predisposed kidney to hypovolumic injury. | # '''Hypovoluemia induced kidney injury:''' It occurs due to loss of fluid through [[Gastrointestinal tract|GIT]] or [[Gastrointestinal tract|GI]] bleed in presence of liver failure which predisposed [[kidney]] to hypovolumic injury. | ||
# '''Parencheymal renal disease:''' In presence | # '''Parencheymal renal disease:''' In presence [[proteinuria]] above 500 mg/dl and [[hematuria]] above 50 red cells points to kidney injury primarily otherwise it points to liver damage promoting kidney injury. | ||
# '''Drug induced hepato-nephrotoxicity:''' When drugs like acetaminophen and anti microbial causing | # '''Drug induced hepato-nephrotoxicity:''' When drugs like [[acetaminophen]] and anti microbial causing [[hepatotoxicity]] and [[nephrotoxicity]] are taken together they can also produce combed damage. | ||
==References== | ==References== | ||
Latest revision as of 19:27, 21 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sunny Kumar MD [2]
Overview
The classification of hepatorenal syndrome is based on the deteriorating function of kidney in to two types: type 1 rapidly progressive and type 2 HRS, slowly progressive.
Classification
The hepatorenal syndrome is defined as renal failure that occurs in the setting of liver disease as follows:
Type I HRS
Type I HRS is characterized by rapidly progressive renal failure with a doubling of serum creatinine to a level greater than 221 μmol/L (2.5 mg/dL) or a halving of the creatinine clearance to less than 20 mL/min over a period of less than 2 weeks.
Type II HRS
Type II HRS is characterized by a slowly progressive:
- Increase in serum creatinine level to greater than 133 μmol/L (1.5 mg/dL) or a creatinine clearance of less than 40 mL/min.
- Urine sodium < 10 meq/dl. [1]
Classification on basis of mechanism of kidney injury in presence of liver failure:
- Hypovoluemia induced kidney injury: It occurs due to loss of fluid through GIT or GI bleed in presence of liver failure which predisposed kidney to hypovolumic injury.
- Parencheymal renal disease: In presence proteinuria above 500 mg/dl and hematuria above 50 red cells points to kidney injury primarily otherwise it points to liver damage promoting kidney injury.
- Drug induced hepato-nephrotoxicity: When drugs like acetaminophen and anti microbial causing hepatotoxicity and nephrotoxicity are taken together they can also produce combed damage.