Abstract: PUB008
Cryptogenic Liver Cirrhosis and Hepatorenal Syndrome (HRS) Management in Developing Countries
Session Information
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Bacci, Marcelo Rodrigues, Faculdade de Medicina do ABC, Santo Andre, Brazil
- Ranieri, Fernanda Rodrigues, Faculdade de Medicina do ABC, Santo Andre, Brazil
- Ferreira, João Victor Di Giacomo, Faculdade de Medicina do ABC, Santo Andre, Brazil
Introduction
HRS is a renal dysfunction secondary to liver failure and portal hypertension.Increased vasodilator circulation causes reduced effective blood volume,activation of the renin angiotensin-aldosterone system.This hormone storm has engulfed the kidneys, necessitating the exclusion of other potential causes of their failure.In the past few decades,HRS definition has changed,which has contributed to the difficulty in understanding a correct diagnosis.In this case report,we describe a HRS female patient with a late referral to the nephrologist after hospital discharge.
Case Description
A 62-year-old female presented with jaundice,ascitis and confusion,requiring hospitalization.She had a history of liver disease with no proper investigation and 15 years of evolution.A nephrologist was called upon admission due to kidney failure.She had no history of drug abuse, alcohol consumption,sepsis or viral infection.There was no answer with volume expansion.The medical team performed a liver biopsy but kidney biopsy was not considered.The medical team did not classify the HRS properly as no data of previous creatinine was available.The patient evolved to permanent conventional dialysis.Following discharge,the patient visited an outpatient nephrologist which classified as HRS non-acute kidney injury(NAKI)due to acute kidney disease(AKD).The liver biopsy revealed cryptogenic liver cirrhosis.
Discussion
There has been a recent change in the classification of HRS.What used to be HRS1 became HRS-AKI.HRS2 transitioned to HRS-NAKI,which further categorizes into AKD or CKD.We still have a thorough understanding of HRS new acronyms.It is common practice in developing countries to categorize HRS patients without considering their specific causes due to lack of resources.Brazil is a developing country with a universal health system,however there are few hospitals with proper liver-kidney support and integrated electronic medical records.Kidney and liver biopsies are not easy to get at the most of these hospitals.Liver dialysis is not available and usually these patients need to wait for an outpatient nephrologist for adequate treatment.In summary,knowledge about the new HRS classification still requires attention.A better educational training with a robust differential diagnosis and better access to the patient's medical history are keys to success.