Therapeutic alternatives for the treatment of type 1 hepatorenal syndrome: A Delphi technique-based consensus

Table 1 Criteria for the diagnosis of hepatorenal syndrome

HRS

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

HRS-1

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

HRS-2

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

HRS: Hepatorenal syndrome; HRS-2: Type-2 HRS; HRS-1: Type-1 HRS.