Renal failure in cirrhosis: Emerging concepts

Table 1 The diagnosis of hepatorenal syndrome according to the original (1996) and revised (2007) International Ascites Club criteria

Criteria for HRS-1 (1996)	Revised criteria for HRS-1 (2007)
Major criteria	Presence of cirrhosis with ascites
Chronic or acute liver disease with advanced hepatic failure and portal hypertension	SCr > 1.5 mg/dL
Low GFR: SCr > 1.5 mg/mL or 24 h SCr clearance < 40 mL/min	No improvement of SCr levels after at least 2 d of diuretic
Absence of shock, ongoing bacterial infection or treatment with nephrotoxic drugs	withdrawal and volume expansion with albumin (1 g/kg of
or gastrointestinal or renal fluid losses	body weight per day up to a maximum of 100 g/d)
No sustained improvement in renal function following diuretic withdrawal and	Absence of shock
expansion of plasma volume with at least 1500 mL of isotonic saline	No current or recent treatment with nephrotoxic drugs
Proteinuria < 0.5 g/d and no evidence of obstructive nephropathy or	Absence of parenchymal kidney disease as indicated by
parenchymal renal disease on ultrasound	proteinuria > 500 mg/d, microhaematuria (> 50 red blood cells
Additional criteria	per high power field) and/or abnormal renal ultrasonography
Urinary volume < 0.5 L/d
Urinary sodium < 10 mmol/L
Urinary osmolality > plasma osmolality
Urinary red blood cells < 50 high power field
Serum sodium concentration < 130 mmol/L

Adapted from Arroyo et al[12] and Salerno et al[13]. SCr: Serum creatinine; GFR: Glomerular filtration rate; HRS: Hepatorenal syndrome.