HRS-AKI Terlipressin — ESENeph MCQ

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ModerateAcute Kidney InjuryHRS-AKI TerlipressinESENeph

A 60-year-old man with decompensated cirrhosis (Child-Pugh C) develops AKI with creatinine rising from 80 to 200 umol/L. He has tense ascites and is jaundiced. Urine sodium is <10 mmol/L. There is no infection, nephrotoxin exposure, or obstruction. He does not respond to albumin challenge (1 g/kg for 2 days). What is the diagnosis and first-line vasoconstrictor?

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Correct answer: E — Hepatorenal syndrome type 1 (HRS-AKI) – first-line vasoconstrictor is Terlipressin plus IV albumin

HRS-AKI (previously type 1 HRS) is defined by ICA criteria: cirrhosis with ascites, AKI not responding to volume expansion (albumin 1 g/kg x 2 days), no nephrotoxins, no shock, no structural kidney disease. Urine sodium <10 mmol/L reflects intense renal vasoconstriction. Terlipressin (vasopressin V1 receptor agonist) with IV albumin is the first-line vasoconstrictor (NICE NG50, CONFIRM trial). It reverses splanchnic vasodilation and improves renal perfusion. Liver transplant is the definitive treatment.

Reference: NICE NG50 2016 – Cirrhosis; ICA-AKI Criteria 2015; CONFIRM Trial – NEJM 2021