An interesting review of hepatorenal syndrome (HRS) by Fagundes and Ginès was recently published in the American Journal of Kidney Diseases. The authors review the pathophysiology and treatment options for HRS with latest evidence-based data. We have developed a set of anagrams to explore and test your knowledge of HRS.

An anagram is a type of word play, a set of jumbled letters that can be rearranged to find a hidden answer (original word/phrase). For example, “main party here (1 word)” is an anagram for “hypernatremia.” The anagrams below bring to the reader’s attention some of the important factors to consider while obtaining a history, physical examination, and laboratory data in the evaluation of a patient with a HRS. Each anagram is followed by a hint meant to intellectually direct the reader towards the correct answer. The number of words that would form the final answer is indicated in parentheses next to the anagram.

1. SLOPPY, THORNIER NEAT (2 words)

This is the inciting event necessary for the splanchnic vasodilatation and loss of effective systemic arterial blood volume that results in severe intrarenal vasoconstriction and HRS.

2. PARAMOUR’S SELECTIVE ANGEL (3 words)

15% of all the cases of HRS include this therapeutic procedure which causes massive intravascular fluid shifts, loss of effective systemic arterial resistance, and kidney injury.

3. LET’S! INSPIRER (1 word)

A 52-year-old man with a history of hepatitis C with cirrhosis is admitted for an elective paracentesis for massive ascites. His paracentesis was uneventful and 7 liters of clear serous fluid is drained. He was given intravenous albumin during the procedure. On the second day of admission, his serum creatinine rose from a baseline of 1.1 mg/dL to 2.3 mg/dL. The kidney function kept deteriorating over the next 3 days with creatinine reaching 4.5 mg/dL despite intravenous normal saline infusion. A renal and bladder sonogram was negative for obstruction. Which drug has been proven in randomized control trials to be beneficial in reversing the kidney injury in this patient?

4. BUM NAIL (1 word)

A 45-year-old woman with known cirrhosis presents with spontaneous bacterial peritonitis. Her diuretic therapy and lactulose are discontinued. Which is the only therapy definitively proven to be effective as prophylaxis in preventing HRS in patients at higher risk for HRS?

Here’s to a fruitful learning experience!

Questions prepared by Ashish Kataria, MD, Nephrology Fellow, Hofstra NSLIJ School of Medicine

Edited by Kenar D. Jhaveri, MD, eAJKD Blog Editor

Answers can be found here.

To view the article abstract or full-text (subscription required), please visit AJKD.org.