Annals for Hospitalists Inpatient Notes - Clinical Pearls—Hepatorenal Syndrome
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Annals for Hospitalists Inpatient Notes - Clinical Pearls—Hepatorenal Syndrome. Ann Intern Med.2021;174:HO2-HO3. [Epub 20 July 2021]. doi:10.7326/M21-2289
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High mortality?
The authors say, "This patient developed hepatorenal syndrome (HRS).Hepatorenal syndrome can be diagnosed in patients with cirrhosis and ascites who have AKI ... despite volume expansion, in the absence of shock, nephrotoxin exposure, proteinuria, and hematuria. Hepatorenal syndrome occurs with an annual incidence of 8% among patients with ascites. One-month survival with HRS-AKI (formerly known as type 1 HRS) is only 34.6% (2), which is substantially increased when HRS is reversed."
This seems unclear. Do 8% of patients with ascites develop HRS annually, two thirds of whom die within a month unless HRS is reversed? Ascites is common. Death from HRS seems much less so. Is treatment so effective? Or is a lot of HRS self-limited? Or other?