Acute renal dysfunction in liver diseases

Table 2 Diagnostic criteria of HRS

Major criteria
1 Chronic or acute liver disease with advanced liver failure and portal hypertension
2 Low GFR, as indicated by a serum creatinine of > 1.5 mg/dL or a 24-h creatinine clearance < 40 mL/min
3 Exclusion of shock, ongoing bacterial infection, volume depletion, and the use of nephrotoxic drugs
4 No improvement in renal function despite stopping diuretics and volume repletion with 1.5 L of saline
5 No proteinuria or ultrasonographic evidence of obstructive uropathy or parenchymal renal disease
Minor criteria1
1 Urine volume lower than 500 mg/day
2. Urine sodium lower than 10 mEq/L
3 Urine osmolality > plasma osmolality
4 Urine blood cells < 50 per high-power field
5 Serum sodium concentration lower than 130 mEq/L

¹Only major criteria are necessary for the diagnosis of hepatorenal syndrome.