#ecuimres transcript

Healthcare Social Media Transcript

From: Mon Apr 22 0:00:00 PDT 2013
To: Mon Apr 22 8:00:00 PDT 2013

What is #ecuimres? Who were the influencers during this time period? #ecuimres analytics


Healthcare Conference  - Healthcare Tweet Chats  -  Healthcare Analytics

nephondemand
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@amrhaynes #ecuimres thanks for these great tips! Looks like you're learning a lot during the #nightshift
nephondemand
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#FOAMed #ecuimres #Hepatorenal syndrome by @ashartwit: live tweets start in 7 minutes & will b archived here ... http://t.co/2A1DWaGCus
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: = a reversible fxnl #renal impairment in #liver #cirrhosis; key is Reversible
drpurushoth
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#ecuimres @ashartwit presenting hepatorenal syndrome in chairs report
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: in 1950s, MDs identified oliguric pts w/o #proteinuria & normal histology
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: in 1070s theory of #vasoconstriction was articulated as the pathophys of HRS
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: Int'l Ascites Club-have advanced #liver failure w/ CrCL < 40 & no #proteinuria
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: Hepatology 1996 v 23 no 1 has the original criteria for HRS
drpurushoth
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#ecuimres hepatorenal syndrome - urine sodium<10, serum sodium<130, urine output <500
ecuimchiefs
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#FOAMed #ecuimres Type 1 HRS has acute onset, doubling of Creatinine, multi organ failure.
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: 2 main types of HRS distinguished by time of onset(2w) & +MOF (HRS 1)
ecuimchiefs
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#FOAMed #ecuimres Type 2 HRS is more chronic, with slowly worsening creatinine.
ecuimchiefs
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#ecuimres #FOAMed both types associated with high 6 month mortality.
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: type 3 HRS = type 1 or 2 in the setting of pre stablished chronic #kidney dz
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: prevalence type 1 2.6%, type 2 5%
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: 3 theories for pathophys of HRS
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: theory 1: peripheral arterial vasodilation-#cirrhosis causes splanchnic vaso-d
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: splanchnic vaso-d causes peripheral vaso-d --> decreased GFR
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: theory 2: renal sympathetic activity increased --> decreased GFR
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: theory 3: cardiac dysfxn as a result of peripheral vasodilating hormones
nephondemand
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#ecuimres #Hepatorenal syndrome by @ashartwit: no matter which theory u believe, all pathophys ultimately result in #renal vasoconstriction
ecuimchiefs
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#FOAMed #ecuimres When eval renal failure in pt w liver cirrhosis, remember Prerenal failure, ATN, nephrotoxin, are all more common than HRS
drpurushoth
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#ecuimres evaluation of hepatorenal syndrome- history physical --> blood and urine chemistries-->renal USG
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome @ashartwit: management of HRS 1:pts have REALLY high mortality so consider #palliative care
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: HRS 2 mgmt req #liver #transplant; temporize w/ TIPS. 2 decr #portal pressures
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: manage HRS 2 w/reversal of peripheral vaso-d or stimulation of renal vaso-d's
drpurushoth
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#ecuimres #Hepatorenal syndrome- albumin + IV splanchnic vasoconstrictors +TIPS procedure = good bridging therapy for transplant
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: #vasopressin incr systemic vascular resistance : #terlipressin but not in US
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: octreotide stimulates splanchnic vaso-c but useless as monotherapy
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: midodrine alone doesn't work but w/octreotide improves GFR
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: direct renal vaso-d's (dopamine, fenoldopam) don't work
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: non pharmaco treatments = TIPS, #dialysis, OTL #transplant, dual LKTx
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: TIPS reduces vasodilator synthesis/release GUT 56(9):1310
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome @ashartwit: TIPS incr survival & is even better if combined w/OTL tx http://t.co/7h0PGY6OIN
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: ECAD: removes bilirubin & NH3 but minimal mortality benefit CJASN 1(5):1066
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: MARS: eliminates toxins that r bound 2 #albumin - c pic http://t.co/g6L0ZMUJ3n
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: OLT or dual LKTx based on MELD; Gonwa Transplantation 2001
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: dual LKTx v OLTx: ESRD, RRTx > 8w, >30% kidney fibrosis; Am J Transplant 2008
drpurushoth
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#ecuimres no survival advantage on combined liver+kidney vs kidney transplant - unless pt has been on renal replacement therapy.
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: survival @ 30 & 90-days w/different therapies --c pic http://t.co/X1rXd0XJ1G
nephondemand
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#FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: dx HRS correctly b/c mortality is ridiculously high than #cirrhosis pt w/o HRS
srrezaie
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RT @nephondemand: #FOAMed #meded #ecuimres #Hepatorenal syndrome @ashartwit: TIPS incr survival & is even better if combined w/OTL tx h…
srrezaie
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RT @nephondemand: #FOAMed #meded #ecuimres #Hepatorenal syndrome by @ashartwit: survival @ 30 & 90-days w/different therapies --c pic h…

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