Differential Diagnosis of Renal Failure in a Patient with Cirrhosis

Description

A patient with cirrhosis may develop renal failure for a number of reasons. Appropriate management requires identification of the conditions that may be affecting the patient. Mackelaite et al proposed a diagnostic approach to evaluate these patients.

Conditions that need to be considered:

(1) extracellular fluid (ECF) loss with prenal azotemia

(2) nephrotoxic medications

(3) ischemic acute tubular necrosis

(4) glomerulonephropathy

(5) obstructive uropathy

(6) hepatorenal syndrome

Condition	Clue to Look For	Additional Finding
ECF fluid loss	rapid or excessive diuresis, vomiting, diarrhea, hemorrhage, large volume paracentesis, drugs such as NSAIDs or ACE inhibitors causing hemodynamic changes	improves if fluid loss controlled and/or albumin infused
nephrotoxic drugs or chemicals	radiocontrast material, aminoglycoside	improves if nephrotoxic exposure stops but recovery may be delayed
ischemic acute tubular necrosis	hypotension (sepsis, hemorrhage, other)
glomerulonephropathy	proteinuria, dysmorphic red cells or RBC casts in urine sediment	renal biopsy
obstructive uropathy	hydronephrosis, hydroureter, urinary retention	improves after relief of obstruction (unless long-standing)
hepatorenal	portal hypertension with elevated serum creatinine

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Description

Specialty

ICD-10