Hepatorenal syndrome laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
There is no specific marker or imaging test to dignose patients with Hepatorenal syndrome{HRS}. For that reason the diagnosis of HRS is based on criteria for excluding other causes of renal impairment which are seen alongwith cirrhosis. | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
Diagnostic Criteria for HRS: | |||
Major Criteria<ref name="pmid8550036">{{cite journal| author=Arroyo V, Ginès P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G et al.| title=Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. | journal=Hepatology | year= 1996 | volume= 23 | issue= 1 | pages= 164-76 | pmid=8550036 | doi=10.1002/hep.510230122 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8550036 }}</ref> | |||
(i) Chronic or acute liver disease with advanced hepatic failure and portal hypertension. | |||
(ii) Low GFR as indicated by serum creatinine > 1.5 mg/dL or 24 hr creatinine clearance < 40 mL/min. | |||
(iii) Absence of shock, on-going bacterial infection, and current or recent treatment with nephrotoxic drugs and absence of gastrointestinal fluid losses (repeated vomiting or intense diarrhoea) or renal fluid losses (weight loss > 500 g/day for several days in patients with ascites without peripheral oedema or 1000 g/day in patients with peripheral oedema). | |||
(iv) No sustained improvement in renal function (decrease in serum creatinine ≤ 1.5 mg/dL or increase in creatinine clearance to ≥ 40 mL/min) following diuretic withdrawal and expansion of plasma volume with 1.5 L of isotonic saline. | |||
(v) Proteinuria < 500 mg/dL and no sonographic evidence of obstructive uropathy or parenchymal renal disease. | |||
Additional Criteria | |||
(i) Urine volume < 500 mL/day. | |||
(ii) Urinary sodium < 10 mEq/L. | |||
(iii) Urinary osmolality greater than plasma osmolality. | |||
(iv) Urine red blood cells < 50 per high power field. | |||
(v) Serum sodium < 130 mEq/L. | |||
Revised Diagnostic Criteria for HRS: | |||
(i) Cirrhosis with ascites. | |||
(ii) Serum creatinine > 133 μmol/L (1.5 mg/dL). | |||
(iii) No improvement in serum creatinine (decrease to a level of ≤ 133 μmol/L) after ≥ 2 days with diuretic withdrawal and volume expansion with albumin; the recommended dose of albumin is 1 g/kg of body weight/day up to a maximum of 100 g/day. | |||
(iv) Absence of shock. | |||
(v) No current or recent treatment with nephrotoxic drugs. | |||
(vi) Absence of parenchymal kidney disease as indicated by proteinuria > 500 mg/day, microscopic haematuria (>50 red blood cells per high power field), and/or abnormal renal ultrasonography. | |||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
There is no specific marker or imaging test to dignose patients with Hepatorenal syndrome{HRS}. For that reason the diagnosis of HRS is based on criteria for excluding other causes of renal impairment which are seen alongwith cirrhosis.
Laboratory Findings
Diagnostic Criteria for HRS:
Major Criteria[1]
(i) Chronic or acute liver disease with advanced hepatic failure and portal hypertension.
(ii) Low GFR as indicated by serum creatinine > 1.5 mg/dL or 24 hr creatinine clearance < 40 mL/min.
(iii) Absence of shock, on-going bacterial infection, and current or recent treatment with nephrotoxic drugs and absence of gastrointestinal fluid losses (repeated vomiting or intense diarrhoea) or renal fluid losses (weight loss > 500 g/day for several days in patients with ascites without peripheral oedema or 1000 g/day in patients with peripheral oedema).
(iv) No sustained improvement in renal function (decrease in serum creatinine ≤ 1.5 mg/dL or increase in creatinine clearance to ≥ 40 mL/min) following diuretic withdrawal and expansion of plasma volume with 1.5 L of isotonic saline.
(v) Proteinuria < 500 mg/dL and no sonographic evidence of obstructive uropathy or parenchymal renal disease.
Additional Criteria
(i) Urine volume < 500 mL/day.
(ii) Urinary sodium < 10 mEq/L.
(iii) Urinary osmolality greater than plasma osmolality.
(iv) Urine red blood cells < 50 per high power field.
(v) Serum sodium < 130 mEq/L.
Revised Diagnostic Criteria for HRS:
(i) Cirrhosis with ascites.
(ii) Serum creatinine > 133 μmol/L (1.5 mg/dL).
(iii) No improvement in serum creatinine (decrease to a level of ≤ 133 μmol/L) after ≥ 2 days with diuretic withdrawal and volume expansion with albumin; the recommended dose of albumin is 1 g/kg of body weight/day up to a maximum of 100 g/day.
(iv) Absence of shock.
(v) No current or recent treatment with nephrotoxic drugs.
(vi) Absence of parenchymal kidney disease as indicated by proteinuria > 500 mg/day, microscopic haematuria (>50 red blood cells per high power field), and/or abnormal renal ultrasonography.
References
- ↑ Arroyo V, Ginès P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G; et al. (1996). "Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club". Hepatology. 23 (1): 164–76. doi:10.1002/hep.510230122. PMID 8550036.