Sun21November0420PM 15

Which physiological changes are associated with the development of hepatorenal syndrome (HRS)?

(Please select 1 option)

Decreased cardiac output, low arterial pressure, reduced systemic vascular resistance, renal vasodilatation Incorrect answer selected

Increased cardiac output, high arterial pressure, increased systemic vascular resistance, renal vasoconstriction

Decreased cardiac output, high arterial pressure, reduced systemic vascular resistance, renal vasodilatation

Decreased cardiac output, high arterial pressure, increased systemic vascular resistance, renal vasoconstriction

Increased cardiac output, low arterial pressure, reduced systemic vascular resistance, renal vasoconstriction This is the correct answer

Explanation

Hepatorenal syndrome (HRS) is the development of significant acute kidney injury (AKI) with concurrent liver disease. Hepatic impairment from chronic cirrhosis, fulminant liver failure or acute hepatitis is associated with HRS.

The physiological changes associated with HRS include:

Nitric oxide induced vasodilatation of the splanchnic circulation. Other dilators include carbon monoxide, glucagon and peptides

Progressive rise in cardiac output to counterbalance the reduction in arterial preload

Portal hypertension

Reduced systemic vascular resistance with subsequent activation of both the renin-angiotensin system, sympathetic nervous system and arginine vasopressin. These changes lead to renal vasoconstriction, sodium and water retention, ascites and hyponatraemia. The reduction of glomerular filtration rate and urine output may lead to acute tubular necrosis.

The criteria for diagnosis include:

Cirrhosis or fulminant hepatic failure from other causes with ascites

Serum creatinine > 133 µmol/L (1.5 mg/dL).

No improvement in serum creatinine (decrease to a level of = 133 µmol/L) after = 2 days with diuretic withdrawal and volume expansion with albumin; the recommended dose of albumin is 1 g/kg of body weight/day up to a maximum of 100 g/day

Absence of shock

No current or recent treatment with nephrotoxic drugs.

Absence of intrinsic kidney disease as indicated by proteinuria > 500 mg/day, microscopic haematuria (>50 red blood cells per high power field), and/or abnormal renal ultrasonography

Answer Statistics

1

26%

2

4%

3

3%

4

12%

5

58%

Times answered: 275