Hepatorenal Syndrome (Core IM)
Nov 27·Tap to summarize
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/Subscribe to the Substack:https://rokeefemd.substack.com/
