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Hepatorenal syndrome — ABIM Board MCQ

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HardGastroenterology/HepatologyHepatorenal syndromeABIM Board

A patient with decompensated cirrhosis develops oliguria after a variceal bleed. Creatinine rises from 0.8 to 2.4 mg/dL despite stopping diuretics and an adequate albumin challenge. Urinalysis is bland, ultrasound is normal and shock is absent. Which treatment is most appropriate?

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Correct answer: A — Begin terlipressin plus albumin and transplant evaluation

The best answer is “Begin terlipressin plus albumin and transplant evaluation”. The findings support HRS-AKI after volume-responsive and structural causes have been assessed. Terlipressin plus carefully dosed albumin is preferred where available, with monitoring for ischemic and respiratory complications; transplantation is definitive. Diuretics, ACE inhibition and dopamine can worsen effective renal perfusion, while bland urine does not establish interstitial nephritis.

Reference: AASLD: Why patients with cirrhosis are susceptible to hepatorenal syndrome: https://www.aasld.org/liver-fellow-network/core-series/why-series/why-are-patients-cirrhosis-susceptible-hepatorenal