[Part 1 ]Hepatorenal-Syndrome-in-Cirrhosis-A-Comprehensive-Review.pptx

medical analysis

1. Hepatorenal Syndrome in Cirrhosis: A Comprehensive Review Authors: Elisa Pose, Salvatore Piano, Adrià Juanola, Pere Ginès Journal: Gastroenterology 2024;166:588–604 Date: March 22, 2025

2. Introduction to HRS Definition Kidney dysfunction in advanced cirrhosis Key Features Reduced GFR, reversible with treatment Objective Review epidemiology, pathophysiology, diagnosis, management

3. Types of HRS HRS-AKI Acute, severe, often infection-triggered HRS-CKD Chronic, progressive kidney impairment NAKI Emerging term for non-AKI kidney dysfunction

4. Epidemiology of AKI in Cirrhosis Prevalence 27%–53% in hospitalized patients Acquisition Community vs. Hospital-acquired AKI Severity Majority mild-to-moderate (Stage 1)

5. AKI Staging at Diagnosis 69% Stage 1 19% Stage 2 13% Stage 3

6. Main Etiologies of AKI Hypovolemia ~50% (fluid losses) ATN-AKI ~25% (tubular necrosis) HRS-AKI ~25% (circulatory dysfunction)

7. Risk Factors for HRS-AKI Primary Trigger Bacterial infections (SBP, 30% incidence) Other Factors Large-volume paracentesis, GI bleeding Prevention Albumin reduces risk in SBP

8. Prognosis of AKI Stage 90-day Survival Stage 1A 84% Stage 1B 56% Stage 2 48% Stage 3 43%

9. Prognosis by Etiology Hypovolemia Best prognosis Most responsive to intervention HRS-AKI Intermediate prognosis Requires specialized treatment ATN-AKI Worst prognosis Limited reversal options

10. Pathophysiology Overview Core Mechanism Circulatory dysfunction in decompensated cirrhosis Contributors Systemic inflammation Complications Cirrhotic cardiomyopathy, altered renal blood flow