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Hepatorenal syndrome and large-volume paracentesis

By: Fidelindo Lim, DNP, CCRN, and John Raterman, BFA, BSN, RN

Averting a Crisis.


  • Hepatorenal syndrome (HRS), impaired renal function resulting from advanced liver disease, is characterized by renal vasoconstriction, systemic vasodilatation in the absence of other identifiable causes, decreased glomerular filtration rate, and hypotension. 
  • Large-volume paracentesis is defined as removing 5 liters or more of ascitic fluid during paracentesis, which is both diagnostic and therapeutic.  
  • HRS management goals are centered around preserving hepatic function, treating symptoms of cirrhosis, and maximizing renal function. 
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