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Acute Complications of Cirrhosis Masterclass by Sarah Kessler, PharmD, BCPS, BCGP

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  • Main etiologies for acute kidney injury (AKI) in cirrhosis
    • Prerenal
      • Hypovolemia
      • HRS-AKI (previously type 1 and 2)
    • Acute tubular necrosis (ATN)
      • Typically due to sepsis
      • Less commonly due to medications
  • All other causes of AKI must be excluded before a diagnosis of HRS can be made
    • Differentiating between these is difficult and requires careful work up of all the above causes


Therapy Dosing
First Line Recommendations
Albumin – 1g/kg day 1, followed by 40-50g daily
Vasopressors -Terlipressin is preferred, but not available in the US (pending FDA approval)

-InĀ  place of terlipressin, norepinephrine may be used

Octreotide – 100-200 mcg subcutaneously TID
Midodrine – 5-15mg orally TID