Rare diseases are often given importance at Grand Rounds everywhere. Dartmouth is no exception. Esoteric is exciting, in medicine too! Today's topic Hepato-Renal Syndrome by Dr Block, is remarkably rare. It is a manifestation of end stage liver disease. We hear about MELD scores and renal/ kidney cortical venoconstriction. International Ascites Club... gets a good laugh. They have criteria to diagnose it. Type 1 die quickly without liver transplantation. Other types..2,3,4 live somewhat longer. New to me, fancy markers of Acute Kidney injury, Cystatin C and NGAL are talked about. More esoterica. Mayo does these tests. Apparently the results of these do not help patients. But keep your eyes out for these anyway. Great on rounds to impress your colleagues! And for high scores on tests! At DHMC they have not done too many trans venous kidney biopsies, Dr Block says. Can help clarify the causes of the kidney problems. In expert hands it is listed as safe. Sympathetic nervous s