Wednesday, February 23, 2011

TOPIC DISCUSSION: Is Veno-occlusive disease associated AKI different from Hepatorenal syndrome?

One of the devastating complications of bone marrow transplants is veno occlusive disease(VOD) characterized by weight gain, painful hepatomegaly, ascites, jaundice, bilirubin levels astronomically high.  This usually happens 30 days following the transplant.
VOD associated AKI is clinically not different from Hepato renal syndrome. Patients usually have a a pre renal picture with oliguria, low FENa and clinically appear volume overloaded.  Patients are either hypotensive or normotensive and hyponatremia might be present. Hence looks very similar to a cirrhotic patient with acute renal injury.  Tubular damage can be seen with granular casts in advanced disease and perhaps some component of pigment(bilirubin) nephropathy.  When kidney biopsies are done in the patients, there are no structural damages noted unless ATN has ensued.  Hence, the pathophysiology is similar to hepatorenal syndrome essentially.
Makes the injury mostly volume related or hemodynamic in nature or a "false" permanent activation of renin angiotensin system: like hepato renal syndrome

Cancer and the Kidney, Second edition, Eric Cohen

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