Today’s case was that of a 75 year old female with past history of cryptogenic cirrhosis, diabetes mellitus and chronic renal insufficiency, who presented to the hospital with acute on chronic liver disease and acute kidney injury. The pattern of rise in LFT and creatinine suggested ischemic injury.
Oftentimes, ischemic hepatopathy is seen in context with a bump in BUN and creatinine, as both vital organs are transiently hypoperfused. Nevertheless, a workup for hepatorenal syndrome was undertaken, HRS treatment was initiated, and there was no therapeutic response from the kidney perspective. At the end, the differential remained HRS vs. (ischemic) ATN.
Some of today’s learning points included:
– caution with serum sodium interpretation when hyperglycemia is present
– caution should be given not to drastically volume overload a sick cirrhotic/CRI patient when they present with acute illness
– in an ideal circumstance, these patients would be in an intensive care setting with intravascular volume monitoring to help guide therapy
– the classic HRS-1 patient is somebody with cirrhosis, hyponatremia and diuretic-resistant or refractory ascites