Hepatorenal syndrome

Cirrhosis with ascites
Diagnosis of AKI according to ICA AKI Criteria:
- Increase in serum creatinine ≥0.3 mg/dL within 48 hours, or
- A percentage increase serum creatinine ≥50% from baseline which is known, or presumed, to have occurred within the prior 7 days
No response after 2 consecutive days of diuretic withdrawal and plasma volume expansion with albumin
Absence of shock
No current or recent treatment with nephrotoxic drugs
Absence of parenchymal kidney disease as indicated by proteinuria >500 mg/day, microhematuria (>50 red blood cells per high power field), and/or abnormal renal ultrasonography.

These include:

Cirrhosis with ascites
Serum creatinine >1.5 mg/dL
Absence of shock
Absence of hypovolemia as defined by no sustained improvement of renal function (creatinine decreasing to <1.5 mg/dL) following at least 2 days of diuretic withdrawal (if on diuretics), and volume expansion with albumin at 1 g/kg/day up to a maximum of 100 g/day
No current or recent treatment with nephrotoxic drugs
Absence of parenchymal renal disease as defined by proteinuria <0.5 g/day, no microhematuria (<50 red blood cells per high power field), and normal renal ultrasonography.

Diagnosis of HRS-AKI

Cirrhosis with ascites
Diagnosis of AKI according to the ICA-Acute Kidney Injury Criteria (i.e., increase in serum creatinine ≥0.3 mg/dL within 48 hours; or a percentage increase serum creatinine ≥50% from baseline which is known, or presumed, to have occurred within the prior 7 days)
No response after 2 consecutive days of diuretic withdrawal and plasma volume expansion with albumin infusions (1g/kg body weight per day)
Absence of shock
No current or recent use of nephrotoxic drugs (nonsteroidal anti-inflammatory drugs, aminoglycosides, or iodinated contrast media)
No signs of structural kidney injury, as indicated by proteinuria (>500mg per day), microhematuria (>50 red blood cells per high power field), and /or abnormal renal ultrasonography.

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