Hepatorenal Syndrome (HRS)

Diagnosis

Main etiologies for acute kidney injury (AKI) in cirrhosis
- Prerenal
  - Hypovolemia
  - HRS-AKI (previously type 1 and 2)
- Acute tubular necrosis (ATN)
  - Typically due to sepsis
  - Less commonly due to medications
All other causes of AKI must be excluded before a diagnosis of HRS can be made
- Differentiating between these is difficult and requires careful work up of all the above causes

Therapy	Dosing
First Line Recommendations
Albumin	– 1g/kg day 1, followed by 40-50g daily
Vasopressors	-Terlipressin is preferred, but not available in the US (pending FDA approval) -In place of terlipressin, norepinephrine may be used
Alternatives
Octreotide	– 100-200 mcg subcutaneously TID
Midodrine	– 5-15mg orally TID