Algorithm for the Diagnosis and Treatment of Hepatorenal Syndrome
AKI and Cirrhosis → Diagnostics and Early Treatment:
1. Check urine Na, sediment, renal U/S
2. Remove risk factors (nephrotoxic drugs, NSA/Ds, withdraw diuretics, treat infections/GlB, vasodilators/antihypettensives)
3. Volume expansion with albumin if indicated (suggest 1g/kg/day)
After 48h of initial treatment, has scr returned to 0.3 mg/dL of baseline?
Meets criteria for HRS?
• Cirrhosis and ascites
• No shock
• No recent nephrotoxic drugs
• No signs of structural kidney injury (< 500 mg/day proteinuria, RBCs/HPF, normal renal US, inactive sediment)
MAP-Directed Treatment of HRS:
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