The kidney is commonly affected by liver cirrhosis. Knowledge of kidney diseases in cirrhosis is important. Gonwa and Wadei discuss this topic in a recent Core Curriculum in AJKD. The following questions will test your knowledge on this topic:

1. The 4-variable MDRD equation is a reliable tool to assess kidney function in patients with cirrhosis.

A. True
B. False

2. A 46-year-old man with advanced alcoholic liver disease presents with worsening abdominal distension. Except for chronic fatigue, mild difficulty breathing, and not eating well for the last few days, he does not have any other symptoms. Physical exam reveals tense ascites. Bloodwork shows a serum sodium level of 128 mEq/L and creatinine level of 0.8 mg/dL. What would be the best approach to correct his serum sodium level?

A. Hemodialysis with high sodium dialysate at 145 mEq/L

B. Free water restriction and a loop diuretic

C. Infusion of 3% saline

D. Vasopressin-2 receptor blocker, tolvaptan

E. Vasopressin-1A and 2 receptor blocker, conivaptan

3. Hepatorenal syndrome (HRS) is the most common cause of acute kidney injury (AKI) in cirrhosis.

A. True

B. False

4. Which of the following best explains the underlying pathophysiologic change that leads to HRS?

A. Direct kidney infection by Hepatitis B or C virus

B. Acute tubular necrosis

C. Complement-mediated injury and crescent formation in glomeruli

D. Increased splanchnic vasodilation mediated by nitric oxide

E. Renal vasoconstriction due to activation of renin-angiotensin-aldosterone system (RAAS)

F. Reduced intrarenal production of vasodilating prostaglandins

G. Combination of D, E, and F

5. You are asked to see a cirrhotic patient with oliguric AKI and a serum creatinine of 3.2 mg/dL. He was admitted one week ago with confusion due to hepatic encephalopathy when his creatinine was 1.4 mg/dL. The primary hepatology team has already tried volume resuscitation with albumin and holding furosemide, with no success. After your evaluation, and ruling out other causes, you make a diagnosis of HRS. Which of the following is NOT part of the treatment of HRS in this scenario?

A. Octreotide

B. Terlipressin

C. Midodrine

D. Norepinephrine

E. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Post Prepared by Veeraish Chauhan, MD, Lakewood Ranch, Florida, USA.

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