Renal dysfunction in patients with cirrhosis: Where do we stand?

Table 5 Recomendations for management of patients with cirrhosis

First line therapy
Recognize and withdraw all causes of acute kidney disease
Resolve primary liver disease
Encounter hypoalbuminemia with albumin infusion and tension ascites with repeated paracentesis plus albumin
Have a high level of suspicion and treat spontaneous bacterial peritonitis
Be vigilant and have into close monitoring patients win acute kidney injury network stage 1 and sCr > 1.5 mg/dL (133 μmol/L) or initial acute kidney injury network stage > 1
If there is no improvement within 2 d, proceed to specific treatment measures
Second line therapy
Patients hospitalized at the ward	If the diagnosis of hepatorenal syndrome has been placed:
	Give albumin and terlipressin in continuous infusion
	If there is improvement within 4 d continue with oral midrodrine
	When terlipressin is unavailable:
	Give midrodrine plus octreotide plus albumin
Patients admitted to intensive care unit	Norepinephrine plus albumin
Third line therapy
Patients who qualify for transplant	Consider liver or simultaneous liver kidney transplantation
	Give therapeutic bridges – Dialysis, transjugular intrahepatic portosystemic shunt
Patients who do not qualify for transplant	Continue the combination of terlipressin plus albumin
	Dialysis, TIPS