Hepatorenal Syndrome — RACP Adult Medicine MCQ

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HardGastroenterologyHepatorenal SyndromeRACP Adult Medicine

A 60-year-old man with alcoholic cirrhosis presents with oliguric AKI (creatinine rising from 90 to 280 μmol/L over 1 week). He has tense ascites and jaundice. Urinalysis is bland (no protein, no blood). Urine sodium is <10 mmol/L. He does not respond to 2 days of IV albumin challenge (1 g/kg/day). What is the most likely diagnosis?

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Correct answer: D — Hepatorenal syndrome

Progressive AKI in cirrhosis with bland urinalysis, very low urine sodium (<10 mmol/L), and failure to respond to volume expansion (albumin) meets criteria for hepatorenal syndrome (HRS-AKI). It is a functional renal failure due to extreme renal vasoconstriction. Treatment is terlipressin plus albumin. Liver transplantation is the definitive treatment.

Reference: GESA – 2024 – HRS; EASL 2024 Decompensated Cirrhosis