Hepatorenal syndrome laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sunny Kumar MD [2]
Overview
There is no specific marker or imaging test to diagnose 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 along with 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 diarrhea) or renal fluid losses (weight loss > 500 g/day for several days in patients with ascites without peripheral edema or 1000 g/day in patients with peripheral edema).
(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:[2]
(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 hematuria (>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.
- ↑ Salerno F, Gerbes A, Ginès P, Wong F, Arroyo V (2007). "Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis". Gut. 56 (9): 1310–8. doi:10.1136/gut.2006.107789. PMC 1954971. PMID 17389705.