HRS-AKI Terlipressin Albumin Treatment — ESENeph MCQ

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HardAcute Kidney InjuryHRS-AKI Terlipressin Albumin TreatmentESENeph

A 48-year-old man with end-stage liver disease (Child-Pugh C cirrhosis) and ascites develops AKI with creatinine rising from 90 to 240 umol/L over 72 hours. Urine output is <200 mL/day. He has no signs of sepsis or nephrotoxic drug exposure. Albumin challenge (1 g/kg for 2 days) produces no improvement. Urine sodium is <10 mmol/L. What is the specific treatment for this condition?

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Correct answer: D — Terlipressin plus IV albumin

This presentation meets criteria for hepatorenal syndrome-AKI (HRS-AKI), formerly type 1 HRS: AKI in cirrhosis without other identifiable cause, unresponsive to albumin challenge. The diagnostic criteria (ICA-AKI 2015) require exclusion of nephrotoxic drugs, sepsis, and structural kidney disease. Terlipressin (a vasopressin V1 receptor agonist) plus IV albumin is the recommended first-line specific treatment per EASL and NICE guidelines. Terlipressin causes splanchnic vasoconstriction, improving effective arterial blood volume and renal perfusion. The CONFIRM trial demonstrated improved renal function with terlipressin. Midodrine-octreotide is an alternative when terlipressin is unavailable. Liver transplant is the definitive treatment.

Reference: EASL 2023 – Cirrhosis Decompensation; Wong et al 2021 – CONFIRM Trial; NICE 2016 – NG50 Cirrhosis