Helixtalk - Rosalind Franklin University's College Of Pharmacy Podcast

In this episode, we provide a concise overview of the diagnosis and treatment of hepatorenal syndrome-acute kidney injury (HRS-AKI) with a focus on the new HRS-1 definition (now called HRS-AKI), new data with terlipressin, and the AASLD 2021 guidelines. Key Concepts At a basic level, HRS-AKI is caused by portal hypertension leading to systemic vasodilation and a prerenal state.  Our treatment focuses on increasing vascular volume (usually with albumin) and vasoconstriction to increase renal perfusion. The newest HRS-AKI definition borrows most of the AKI definitions from the KDIGO criteria for AKI.  HRS-AKI requires cirrhosis, ascites, AKI, and an exclusion of other etiologies of AKI. In AKI and HRS-AKI, concentrated (25%) albumin is given. A dose of 1 gm/kg/day (max 100 gm) for two days is used for AKI.  For HRS-AKI, a dose of 20-50 grams/day is recommended. The preferred vasoconstrictor in HRS-AKI is terlipressin; however, it is not available in the US. Norepinephrine (if in the ICU) is second-line.  If no