phuluong2k wrote:
There are no indications in this question to suggest that the patient requires acute hemodialysis (choice B).
patient is confused and altered mental status is an indication for dialysis. I thought about hepatorenal and liver transplantation but chose dialysis as this is what is needed rite now. More over there is not enough data to reach the diagnosis of hepatorenal syndrom
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| nisha
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- The diagnosis of HRS is one of exclusion and depends mainly on serum creatinine level, as no specific tests establish the diagnosis of HRS. Although serum creatinine level is a poor marker of renal function in patients with cirrhosis, no other validated and reliable noninvasive markers exist for monitoring renal function in these patients.
- Diagnosis of HRS is based on the presence of a reduced GFR in the absence of other causes of renal failure in patients with chronic liver disease. The following criteria, as proposed by the International Ascites Club in 1996, help diagnose HRS:
- Major criteria (All major criteria are required to diagnose HRS.)
Low GFR, indicated by a serum creatinine level higher than 1.5 mg/dL or 24-hour creatinine clearance lower than 40 mL/min
Absence of shock, ongoing bacterial infection and fluid losses, and current treatment with nephrotoxic medications
No sustained improvement in renal function (decrease in serum creatinine to <1.5 mg/dL or increase in creatinine clearance to >40 mL/min) after diuretic withdrawal and expansion of plasma volume with 1.5 L of plasma expander
Proteinuria less than 500 mg/d and no ultrasonographic evidence of obstructive uropathy or intrinsic parenchymal disease - Additional criteria (Additional criteria are not necessary for the diagnosis but provide supportive evidence.)
- Urine volume less than 500 mL/d
Urine sodium level less than 10 mEq/L
Urine osmolality greater than plasma osmolality
Urine red blood cell count of less than 50 per high-power field
Serum sodium concentration greater than 130 mEq/L
(courtsey emedicine.com)
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| ARJ
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That was worth knowing
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| mani
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pt's medicine history is not given in question tem, vitals r not there so we cant judge shock.urine osmolarity is not given, serum Na not given. sonographic findings not given, urine protein not given.....
thats why i sadi that there is not enough ground for diagnosis of HRS
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The scary part is, in the real exam there'll b even less relavent info given 
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