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©The Author(s) 2022.
World J Gastroenterol. Oct 21, 2022; 28(39): 5666-5678
Published online Oct 21, 2022. doi: 10.3748/wjg.v28.i39.5666
Published online Oct 21, 2022. doi: 10.3748/wjg.v28.i39.5666
Table 1 Key components of clinical assessment and management in COVID-19 induced hepatorenal syndrome
Clinical Assessment of HRS | Management of HRS |
Medical history: (1) Identify likely course of disease progression; and (2) rule out other causes of acute liver injury/fulminant liver failure | Minimize potential drug-induced hepato- and nephron-toxicities: (1) Monitor response to immunosuppressive treatments; (2) monitor response to antivirals and other COVID-19 treatment regimes; and (3) aim to prescribe these medications through a dose-dependent approach |
Clinical examination: (1) Identify signs of systemic and/or respiratory decompensation; (2) identify evidence of cirrhosis/decompensated liver disease; and (3) monitor for oliguria | Medical management strategies in COVID-19 induced HRS: (1) Extracorporeal membrane support therapy & dialysis; (2) potential utilization of MARS or other liver support devices; (3) TIPSS to reduce portal vein pressure (if renal function allows and known CLD); (4) adding intravenous albumin to other procedural/medical therapies to expand plasma volume; and (5) combined use of Midodrine (α-agonist) and Octreotide (somatostatin analogue) to regulate blood vessel tone in the gastrointestinal tract and act as systemic vasoconstrictors to inhibit splanchnic vasodilation. Terlipressin may be used as an alternative |
Laboratory and imaging tests: (1) Confirm positive COVID-19 status; (2) assess systemic hemodynamic stability through basic observations; (3) chest imaging to assess degree of COVID-19 severity for the respiratory system; (4) serum tests to evaluate the degree of inflammation; (5) liver pathology could be evaluated via serum markers (e.g., increased ALT, AST, total bilirubin, GGT and ALP, reduction in albumin) and liver ultrasound; (6) urinalysis to identify low urine sodium i.e., < 10 mmol/L, proteinuria, hematuria and urinary casts seen in ATN; (7) serum eGFR reductions, low serum sodium (dilutional hyponatremia) and elevated plasma renin would be classically observed in HRS; and (8) kidney ultrasound should be performed to rule out obstruction of the kidney outflow tract | Consider liver transplantation if kidney function and hepatic recovery is unlikely with medical management |
- Citation: Wu HHL, Athwal VS, Kalra PA, Chinnadurai R. COVID-19 and hepatorenal syndrome. World J Gastroenterol 2022; 28(39): 5666-5678
- URL: https://www.wjgnet.com/1007-9327/full/v28/i39/5666.htm
- DOI: https://dx.doi.org/10.3748/wjg.v28.i39.5666