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
Table 2 Levels of evidence according to the study design
Level of evidenceDescription
Type IEvidence obtained at least from one well-designed, randomized, controlled1 trial or from a systematic review of randomized clinical studies
Type IIII-1 evidence obtained from non-randomized, prospective, controlled1 studies
II-2 evidence obtained from cohort observational studies2 or case-control studies, preferably multi-centric
II-3 evidence obtained from case series
Type IIIOpinion of authorities on the subject matter based on expertise, expert committees, case reports, pathophysiological studies or basic science studies
Table 3 Levels of recommendation according to the available evidence
AThe consensus strongly recommends the mentioned intervention or service. This recommendation is based on high quality evidence, with a benefit that significantly exceeds the risks
BThe consensus recommends the regular clinical use of the mentioned intervention or service. This recommendation is based on moderate quality evidence, with a benefit that exceeds the risks
CThe consensus does not make any positive or negative recommendation regarding the mentioned intervention or service. A categorical recommendation is not provided, because the evidence (of at least moderate quality) does not show a satisfactory risk/benefit relationship. The decision has to be made on a case-by-case basis
DThe consensus makes a negative recommendation against the mentioned intervention or service. The recommendation is based on at least moderate quality evidence, not showing any benefit or where the risk or damage exceeds the benefits of the intervention
IThe consensus concludes that the evidence is insufficient, due to low-quality studies, heterogeneous results or because the risk/benefit balance cannot be determined