Hepatorenal syndrome

Table 2 Diagnostic criteria of hepatorenal syndrome¹

Major criteria (all must be present for the diagnosis of HRS)

(1) Advanced hepatic failure (acute or chronic liver disease) and portal hypertension

(2) Low GFR defined as serum creatinine > 1.5 mg/dL or creatinine clearance < 40 mL/min

(3) Absence of shock, significant volume losses, ongoing infection, or treatment with nephrotoxic medications

(4) Absence of a sustained improvement in renal function after cessation of diuretics and expansion of plasma volume with 1.5 L of isotonic fluids

(5) Urine protein excretion < 500 mg/dL with no ultrasonographic evidence of obstruction or parenchymal renal disease

Additional criteria (not necessary for the diagnosis, but provide supportive evidence)

(1) Urine volume < 500 mL/d

(2) Urine sodium < 10 mEq/L

(3) Urine osmolality greater than plasma osmolality

(4) Urine red blood cells < 50 per high-power field

(5) Serum sodium concentration < 130 mEq/L

¹Adapted from Arroyo et al[2].