Hepatorenal Syndrome

• Emergency physicians evaluate patients with cirrhosis and ascites daily.
• Patients with cirrhosis are particularly susceptible to acute kidney injury (AKI), which is associated with a significant increase in hospital mortality.
• Hepatorenal syndrome (HRS) is a specific type of renal dysfunction in patients with cirrhosis and ascites.
• The previous classification of HRS (Type 1, Type 2) has now been replaced by HRS-AKI, HRS-AKD, and HRS-CKD.
• The diagnostic criteria for HRS-AKI include:
  • Increase in creatinine 0.3 mg/dL within 48 hrs or 50% from baseline value within the prior 7 days
  • Lack of improvement in creatinine or urine output within 24 hrs of adequate volume resuscitation
  • Absence of an alternative explanation for AKI
• Management of HRS-AKI centers on accurate volume assessment, timely administration of a splanchnic vasoconstrictor (norepinephrine), administration of 20-25% albumin, and avoidance of additional nephrotoxins.

References

Nadim M, et al. Hepatorenal syndrome in the intensive care unit. Intensive Care Med. 2024; 50:978-981.