Question

Patient with cirrhosis with renal dysfunction, minimal hematuria, and lack of improvement with fluids:

a) Hepatorenal syndrome; Albumin infusion and midodrine
b) Acute tubular necrosis; Fluid restriction and diuretics
c) Prerenal azotemia; IV fluids and monitoring
d) Acute interstitial nephritis; Steroids and stopping offending agent

Answer 1

The patient with cirrhosis and renal dysfunction showing no improvement with fluids likely has hepatorenal syndrome and should be treated with albumin infusion and midodrine to improve renal perfusion and blood pressure.

Step-by-step explanation:

The patient in question appears to be suffering from hepatorenal syndrome (HRS), a condition that occurs when there is renal dysfunction due to compromised renal perfusion as a consequence of advanced liver disease, like cirrhosis. The hallmarks of HRS include renal dysfunction, minimal hematuria, and lack of improvement with fluids. The suggested treatment for HRS is the infusion of albumin to expand blood volume and improve kidney perfusion, accompanied by the administration of midodrine to increase blood pressure. This management helps to address the reduced kidney blood flow that is characteristic of HRS.