What are the 2021 ICA revised diagnostic criteria for hepatorenal syndrome?

The International Club of Ascites 2021 criteria for HRS-AKI require: (1) cirrhosis with ascites; (2) AKI (creatinine increase ≥0.3 mg/dL within 48h or ≥1.5× baseline within 7 days); (3) no improvement after 2 days of diuretic withdrawal and volume expansion with albumin 1 g/kg (max 100 g); (4) absence of shock; (5) no exposure to nephrotoxic agents; (6) no parenchymal renal disease (proteinuria 3 months without other cause.

What is the first-line treatment for HRS-AKI?

First-line treatment per EASL/AASLD guidelines is terlipressin (vasoconstrictor) plus albumin. The CONFIRM trial demonstrated terlipressin improved HRS reversal compared to placebo (32% vs 17%) with reduced dialysis requirement, leading to FDA approval in 2022. Norepinephrine is an alternative in ICU settings where terlipressin is unavailable. Midodrine plus octreotide can be used in non-ICU settings but are less effective. Liver transplantation remains the definitive treatment; bridging with renal vasoconstrictors improves post-transplant renal recovery.

Hepatorenal Syndrome Diagnosis

Assess diagnostic criteria for hepatorenal syndrome (HRS-AKI and HRS-NAKI) in cirrhotic patients, distinguishing HRS from pre-renal AKI and intrinsic renal disease.

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Frequently Asked Questions

What are the 2021 ICA revised diagnostic criteria for hepatorenal syndrome?

What is the first-line treatment for HRS-AKI?