Algorithm for the Diagnosis and Treatment of Hepatorenal ...
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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:

 • Albumin

 • Midodrine

 • Octreotide 



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