In patients with liver cirrhosis and portal hypertension, progressive renal dysfunction can result in hepatorenal syndrome–chronic kidney disease (HRS-CKD) — a distinct clinical entity that requires a targeted management approach.
HRS-CKD is diagnosed in a patient with cirrhosis when eGFR is below 60 mL/min/1.73 m² for more than three months in the absence of structural renal disease. This sustained reduction in kidney function, set against the backdrop of cirrhosis and portal hypertension, defines the specific population addressed by this protocol.
Management in this setting involves a portosystemic intervention that is currently considered experimental in hepatorenal syndrome, alongside strategies directed at renal fluid management. The complete sequencing, selection criteria, and full algorithm are available in the structured protocol.
DOI: 10.1016/j.jceh.2022.03.002
If the eGFR is less than 60 mL/min/1.73 m² for more than three months in the absence of structural renal disease, then the patient is labeled as HRS-CKD.
TIPS for HRS is still considered experimental due to the higher incidence of hepatic encephalopathy.
Fluid overload may be overcome with renal replacement therapy, but the optimal timing is unclear.
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