40:I[185,["/_next/static/chunks/3xnt26d00_zk-.js","/_next/static/chunks/1s-yni1uf2lwd.js","/_next/static/chunks/42spz6paskvb6.js","/_next/static/chunks/06x30xgfe6iur.js","/_next/static/chunks/3b4qrzgkt_l12.js","/_next/static/chunks/15lgs8s22dk5l.js"],"SendEmailButton"] 42:I[63625,["/_next/static/chunks/3xnt26d00_zk-.js","/_next/static/chunks/1s-yni1uf2lwd.js","/_next/static/chunks/42spz6paskvb6.js","/_next/static/chunks/06x30xgfe6iur.js","/_next/static/chunks/3b4qrzgkt_l12.js","/_next/static/chunks/15lgs8s22dk5l.js"],"AddToLibraryButton"] 43:I[29721,["/_next/static/chunks/3xnt26d00_zk-.js","/_next/static/chunks/1s-yni1uf2lwd.js","/_next/static/chunks/42spz6paskvb6.js","/_next/static/chunks/06x30xgfe6iur.js","/_next/static/chunks/3b4qrzgkt_l12.js","/_next/static/chunks/15lgs8s22dk5l.js"],"ShareButton"] 44:I[58016,["/_next/static/chunks/3xnt26d00_zk-.js","/_next/static/chunks/1s-yni1uf2lwd.js","/_next/static/chunks/42spz6paskvb6.js","/_next/static/chunks/06x30xgfe6iur.js","/_next/static/chunks/3b4qrzgkt_l12.js","/_next/static/chunks/15lgs8s22dk5l.js"],"ProcessEpisodeButton"] 45:I[45269,["/_next/static/chunks/3xnt26d00_zk-.js","/_next/static/chunks/1s-yni1uf2lwd.js","/_next/static/chunks/42spz6paskvb6.js","/_next/static/chunks/06x30xgfe6iur.js","/_next/static/chunks/3b4qrzgkt_l12.js","/_next/static/chunks/15lgs8s22dk5l.js"],"SignupCTA"] 3a:["$","time",null,{"dateTime":"2025-11-27T01:53:55.000Z","children":"November 27, 2025"}] 41:T522,

The TTS AI voices just couldn't seem to get "terlipressin" right. Don't blame them.

This episode reframes hepatorenal syndrome as a circulatory problem, not a primary kidney disease.

We walk through the core pathophysiology - portal hypertension–driven vasodilation, low effective arterial volume, and intense renal vasoconstriction - and the high-yield labs that separate HRS from ATN: profound hyponatremia, FENa <0.1%, urine Na <20 despite diuretics, and why normal sodium, FENa >0.5%, or muddy brown casts argue against the diagnosis.

We then cover modern management: when (and when not) to give albumin, targeting a MAP rise of 10–15 mmHg with vasoconstrictors, practical use and risks of terlipressin vs midodrine/octreotide, permissive hypercreatinine while diuresing, and the crucial transplant angle - dialysis as a bridge only and how treating HRS can paradoxically worsen a patient’s MELD priority.

Source(s):

https://www.coreimpodcast.com/2025/10/15/hepatorenal-syndrome-5-pearls-segment/

https://www.coreimpodcast.com/2025/10/22/hepatorenal-syndrome-5-pearls-segment-part-2/

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