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Hepatorenal Syndrome
Syn.
Failure hepatorenal
, HRS
Signs & Symptoms
Oliguria
Note:
not all patients with hepatorenal syndrome have oliguria (especially early in its course)
Ref:
Uptodate
[
Hepatorenal syndrome
]
Ascites resistant to diuretics
Ref:
Uptodate
[
Hepatorenal syndrome
]
Harrison
[
2413
]
No nephrotoxic drug exposure
#Club_criteria
Ref:
Cecil
[
357
]
Cecil
[
463
]
Absence of parenchymal kidney disease
#Club_criteria
Note:
indicated by proteinuria of more than 500 mg/day, microhematuria (>50 red blood cells per high-power field), or abnormal renal ultrasonographic findings
Ref:
Cecil
[
357
]
Cecil
[
463
]
Physical Examination
Progressive rise in serum creatinine
Ref:
Uptodate
[
Hepatorenal syndrome
]
Absence of shock
#Club_criteria
Ref:
Cecil
[
357
]
Cecil
[
463
]
Absence of hypovolemia
#Critria
Ref:
Epocrates
[
https://online.epocrates.com/diseases/40236/Hepatorenal-syndrome/Diagnostic-Criteria
]
Lab / Serology
Elevated creatinine
#Club_criteria
Note:
higher than 1.5 mg/dL (133 μmol/L)
Ref:
Uptodate
[
Alcoholic hepatitis: Clinical manifestations and diagnosis
]
Uptodate
[
Hepatorenal syndrome
]
Cecil
[
357
]
Cecil
[
463
]
Lack of improvement in serum creatinine after 2 days of diuretic and volume expansion with albumin
#Club_criteria
Note:
Lack of improvement in the serum creatinine level (to ≤1.5 mg/dL or ≤133 μmol/L) after at least 2 days of diuretic withdrawal and volume expansion with albumin (1 g/kg of body weight per day, up to a maximum of 100 g/day)
Ref:
Cecil
[
357
]
Cecil
[
463
]
Normal urine sediment
Ref:
Uptodate
[
Hepatorenal syndrome
]
Imagin Study
Complication
Risk Factors
Hyponatremia
Ref:
Unknown
[
0
]
High plasma renin activity
Ref:
Unknown
[
0
]
Spontaneous bacterial peritonitis
Ref:
Epocrates
[
https://online.epocrates.com/diseases/40232/Hepatorenal-syndrome/Risk-Factors
]
Cause
Other