Evidence-Based Medicine
Copyright ©The Author(s) 2016.
World J Hepatol. Sep 8, 2016; 8(25): 1075-1086
Published online Sep 8, 2016. doi: 10.4254/wjh.v8.i25.1075
Table 1 Criteria for the diagnosis of hepatorenal syndrome
Presence of cirrhosis and ascites
Serum creatinine > 1.5 mg/dL (or 133 micromoles/L)
No improvement of serum creatinine (decrease equal to or less than 1.5 mg/dL) after at least 48 h of diuretic withdrawal and volume expansion with albumin (recommended dose: 1 g/kg per day up to a maximum of 100 g of albumin/day)
Absence of shock
No current or recent treatment with nephrotoxic drugs
Absence of parenchymal kidney disease as indicated by proteinuria > 500 mg/d, microhematuria (> 50 RBCs/high power field, and/or abnormal renal ultrasound scanning
Rapidly progressive renal failure defined by a doubling of the initial serum creatinine to a level greater than 2.5 mg/dL or 220 μmol/L in less than 2 wk
Although it may appear spontaneously, HRS-1 often develops with a precipitating event, particularly spontaneous bacterial peritonitis
HRS-1 occurs in the setting of an acute deterioration of circulatory function (arterial hypotension and activation of the endogenous vasoconstrictor systems) and is frequently associated to rapid impairment in liver function and encephalopathy
Characterized by a moderate renal failure (serum creatinine greater than 1.5 mg/dL) which follows a steady or slowly progressive course. It appears spontaneously in most cases
HRS-2 is frequently associated with refractory ascites. Survival of patients with HRS-2 is shorter than that of patients with ascites but without renal failure