Guidelines

Criteria for the diagnosis of Hepatorenal Syndrome:

1. Presence of cirrhosis and ascites

2. Serum creatinine >1.5 mg/dL (or 133 micromoles/L)

3. No improvement of serum creatinine (decrease equal to or less than 1.5 mg/dL) after at least 48 hours of diuretic withdrawal and volume expansion with albumin (recommended dose: 1 g/kg b.w. per day up to a maximum of 100 grams of albumin/day)

4. Absence of shock

5. No current or recent treatment with nephrotoxic drugs

6. Absence of parenchymal kidney disease as indicated by proteinuria >500 mg/day, microhematuria (>50 RBCs/high power field, and/or abnormal renal ultrasound scanning

Definition of Type-1 Hepatorenal Syndrome:

Type-1 HRS is characterized by a rapidly progressive renal failure defined by a doubling of the initial serum creatinine to a level greater than 2.5 mg/dl or 220 µmol/l in less than 2 weeks.

Although it may appear spontaneously, type-1 HRS often develops with a precipitating event, particularly spontaneous bacterial peritonitis.

Type-1 HRS occurs in the setting of an acute deterioration of circulatory function (arterial hypotension and activation of the endogenous vasoconstrictor systems) and is frequently associated to rapid impairment in liver function and encephalopathy

Type-1 HRS is associated to very poor prognosis

Definition of Type-2 Hepatorenal Syndrome:

Type-2 HRS is characterized by a moderate renal failure (serum creatinine greater than 1.5 mg/dl or 133 µmol/l) which follows a steady or slowly progressive course. It appears spontaneously in most cases

Type-2 HRS is frequently associated with refractory ascites. Survival of patients with type-2 HRS is shorter than that of patients with ascites but without renal failure