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Renal Support in Hepatic Patient ,[object Object],Lecturer of Anesthesia Ain shams University
Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Introduction ,[object Object],[object Object]
Epidemiology ,[object Object],[object Object],[object Object],[object Object]
Co-existing liver and kidney disease ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
Renal diseases associated with major types of liver disease Membranous glomerulonephritis (GN), membranoproliferative GN, IgA nephropathy, focal segmental glomerulosclerosis Hepatitis B Membranoproliferative GN, membranous GN, cryoglobulinemia, fibrillary GN, IgA nephropathy, tubulointerstitial nephritis Hepatitis C IgA nephropathy Alcoholic liver disease Prerenal azotemia/acute tubular necrosis from hypovolemia, decreased cardiac output, sepsis; acute tubular necrosis Obstructive jaundice Membranous GN, antineutrophil cytoplasmic autoantibody-positive vasculitis, antiglomerular basement membrane disease, renal tubular acidosis, tubulointerstitial nephritis Primary biliary cirrhosis Membranous GN, membranoproliferative GN, antineutrophil cytoplasmic autoantibody-positive vasculitis Primary sclerosing cholangitis Renal tubular acidosis (Type 1) secondary to copper deposition Wilson’s disease Membranoproliferative GN, antiglomerular basement membrane disease Alpha-1 antitrypsin deficiency
Systemic diseases involving both liver and kidney Acetaminophen, ASA Drug toxicity Sarcoidosis Granulomatous diseases Malaria Infectious diseases Amyloidosis Infiltrative diseases Lupus Inflammatory Non alcoholic fatty liver disease Pre-eclapmsia/HELLP   Hmeloysis, elevated liver enzymes, low platelets Autosomal dominant Polycystic kidney/liver disease Sickle cell disease Congestive heart failure, sepsis, hypovolemia Shock states
Serum creatinine concentration for the assessment of kidney function in chronic liver disease ,[object Object],[object Object],[object Object],[object Object],[object Object]
Acute Kidney Injury Network Criteria for staging Acute Kidney Injury ,[object Object]
Acute kidney injury network(AKIN)acute kidney injury  staging criteria
Acute Kidney Injury Pathogenesis ,[object Object],[object Object]
Bacterial infection Large volume paracentesis GIt   bleeding Acute alcoholic hepatitis Renal vasoconstriction Cardiac dysfunction  ( (septic or cirrhotic Worsening hyperdynamic circulation Renal Vasoconstrictor  ↑   Renal Vasodilator  ↓
Biomarkers of AKI ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
` Summary of studies evaluating the role of novel blood and  urine kidney injury biomarkers
Precipitating Factors ,[object Object],[object Object],[object Object],[object Object],[object Object]
Spontaneous Bacterial Peritonitis ,[object Object],[object Object],[object Object]
Aggressive paracentesis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Definition of HRS ,[object Object],[object Object]
Hepatorenal syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis of HRS ,[object Object],[object Object]
Hepatorenal syndrome: Diagnostic criteria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Work-up for patients with suspected HRS  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Assessment of Chronic kidney Disease in patients with chronic Liver disease ,[object Object],[object Object],[object Object]
Staging criteria for chronic kidney disease
Management of HRS Prevention & treatment ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pharmacologic therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Renal support ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
Conclusion ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
THANK YOU

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Renal support

  • 1.
  • 2.
  • 3.
  • 4.
  • 5.
  • 6.
  • 7. Renal diseases associated with major types of liver disease Membranous glomerulonephritis (GN), membranoproliferative GN, IgA nephropathy, focal segmental glomerulosclerosis Hepatitis B Membranoproliferative GN, membranous GN, cryoglobulinemia, fibrillary GN, IgA nephropathy, tubulointerstitial nephritis Hepatitis C IgA nephropathy Alcoholic liver disease Prerenal azotemia/acute tubular necrosis from hypovolemia, decreased cardiac output, sepsis; acute tubular necrosis Obstructive jaundice Membranous GN, antineutrophil cytoplasmic autoantibody-positive vasculitis, antiglomerular basement membrane disease, renal tubular acidosis, tubulointerstitial nephritis Primary biliary cirrhosis Membranous GN, membranoproliferative GN, antineutrophil cytoplasmic autoantibody-positive vasculitis Primary sclerosing cholangitis Renal tubular acidosis (Type 1) secondary to copper deposition Wilson’s disease Membranoproliferative GN, antiglomerular basement membrane disease Alpha-1 antitrypsin deficiency
  • 8. Systemic diseases involving both liver and kidney Acetaminophen, ASA Drug toxicity Sarcoidosis Granulomatous diseases Malaria Infectious diseases Amyloidosis Infiltrative diseases Lupus Inflammatory Non alcoholic fatty liver disease Pre-eclapmsia/HELLP Hmeloysis, elevated liver enzymes, low platelets Autosomal dominant Polycystic kidney/liver disease Sickle cell disease Congestive heart failure, sepsis, hypovolemia Shock states
  • 9.
  • 10.
  • 11. Acute kidney injury network(AKIN)acute kidney injury staging criteria
  • 12.
  • 13. Bacterial infection Large volume paracentesis GIt bleeding Acute alcoholic hepatitis Renal vasoconstriction Cardiac dysfunction ( (septic or cirrhotic Worsening hyperdynamic circulation Renal Vasoconstrictor ↑ Renal Vasodilator ↓
  • 14.
  • 15. ` Summary of studies evaluating the role of novel blood and urine kidney injury biomarkers
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26. Staging criteria for chronic kidney disease
  • 27.
  • 28.
  • 29.
  • 30.
  • 31.
  • 32.
  • 33.
  • 34.
  • 35.