Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:12

694 Hepatitis Delta Virus Hepatorenal Syndrome

■Treatments which fail to eradicate HBsAg (e.g. lamivudine) unlikely

to be of benefit long-term

■Prenylation inhibitors hold great promise (investigational at present)

■Outcome post-liver transplant good

follow-up

■Same as for HBV

complications and prognosis

■Same as for HBV except:

➣course generally more severe

➣HDV increases likelihood of, and rate of progression to, cirrhosis

Hepatorenal Syndrome................................

GABRIEL GARCIA, MD

history & physical

■After onset of cirrhotic ascites, 20% develop HRS in 2 years and 40%

in 5 years

■Two patterns of presentation:

■Type 1 HRS – doubling of serum creatinine or 50% reduction in cre-

atinine clearance within 2 weeks of onset; usually associated with

decompensated liver disease such as variceal bleeding, jaundice,

peritonitis, bacteremia, or encephalopathy

■Type 2 HRS – renal function slowly deteriorates over many weeks to

months in a more stable patient

Major Criteria

■Chronic or acute liver disease with liver failure and portal hyperten-

sion

■Low GFR (serum creatinine >1.5 mg/dL or creatinine clearance

<40 ml/min)

■Absence of shock, bacterial infection or recent treatment with

nephrotoxic drugs

■Absence of excessive fluid losses (gastrointestinal, extensive burn)

■No improvement following volume expansion with at least 1.5 liters

of saline

■No significant proteinuria (<500 mg/day)

■No ultrasound evidence of intrinsic renal