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Hepatorenal Syndrome — RACP Adult Medicine MCQ

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ModerateGastroenterology & HepatologyHepatorenal SyndromeRACP Adult Medicine

A 55-year-old man with advanced cirrhosis (MELD 28) develops hepatorenal syndrome type 1 (HRS-AKI). His creatinine rises from 120 to 350 µmol/L over 5 days. Diuretics have been ceased and albumin administered without improvement. What is the first-line vasoconstrictor treatment in Australia?

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Correct answer: D — Terlipressin

Terlipressin (a vasopressin analogue) is the first-line vasoconstrictor for HRS-AKI, used in combination with IV albumin. The CONFIRM trial demonstrated improved renal function and reduced need for dialysis. It acts by causing splanchnic vasoconstriction, redirecting blood flow to the kidneys. Terlipressin is given as 1 mg IV every 4–6 hours, increasing to 2 mg if creatinine does not fall by ≥25% at day 3. Liver transplant remains the definitive treatment for HRS.

Reference: eTG – 2025 – Gastrointestinal; EASL – 2018 – Decompensated Cirrhosis Guidelines