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Hepatorenal syndrome — ESEGH MCQ

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HardHepatologyHepatorenal syndromeESEGH

A 60-year-old man with decompensated cirrhosis develops acute kidney injury after 4 days of increasing ascites. Diuretics and nephrotoxins are stopped. Urine dip is bland, renal ultrasound is normal and there is no shock. Creatinine rises from 90 to 196 micromol/L despite 48 hours of albumin. What is the most appropriate management?

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Correct answer: C — Terlipressin with ongoing albumin under specialist monitoring

The pattern is consistent with hepatorenal syndrome-AKI after exclusion of structural renal disease, hypovolaemia and shock, and terlipressin plus albumin is recommended where appropriate. Restarting diuretics would worsen renal perfusion. Renal biopsy is not usually required with bland urine and typical physiology. The pearl is that HRS is a diagnosis made after active correction of reversible factors.

Reference: BSG/BASL Ascites in Cirrhosis Guideline; BASL Decompensated Cirrhosis Care Bundle