The Filtrate
Joel Topf
AC Gomez
Sophia Ambruso
Nayan Arora
Special Guest
Charles Edelstein, MD, PhD Professor, Medicine-Renal Med Diseases/Hypertension
Extra-Special Guest
Michelle Rheault, MD Professor of Pediatrics, University of Minnesota
Editing by
Simon and Joel Topf
The Kidney Connection written and performed by by Tim Yau
Show Notes
KDIGO ADPKD Guidelines:
Guideline PDF
NephJC coverage
Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease (CRISP)
Hy’s Law (Wikipedia) has three components:
ALT or AST by 3-fold or greater above the upper limit of normal
And total serum bilirubin of greater than 2× the upper limit of normal, without findings of cholestasis (defined as serum alkaline phosphatase activity less than 2× the upper limit of normal)
And no other reason can be found to explain the combination of increased aminotransferase and serum total bilirubin, such as viral hepatitis, alcohol abuse, ischemia, preexisting liver disease, or another drug capable of causing the observed injury
Meeting this definition yields a very high risk of fulminant kidney failure (76% in one series)
Clinical Pattern of Tolvaptan-Associated Liver Injury in Subjects with Autosomal Dominant Polycystic Kidney Disease: Analysis of Clinical Trials Database (PubMed) Two of 957 patients on tolvaptan met Hy’s law criteria. None had fulminant kid
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