The Relationship between Renal Dysfunction and Abnormalities of the Immune System in Patients with Decompensated Cirrhosis

Table 2

Diagnostic criteria of hepatorenal syndrome (HRS).

Major criteria
(i) Low glomerular filtration rate, as indicated by serum creatinine level greater than 1.5 mg/dL or 24-hour creatinine clearance lower than 40 mL/minute
(ii) Absence of shock, ongoing bacterial infection, fluid loss, and current treatment with nephrotoxic drugs
(iii) No sustained improvement in renal function (decrease in serum creatinine to 1.5 mg/dL or less or increase in creatinine clearance to 40 mL/minute or more) following the diuretic withdrawal and expansion of plasma volume with 1.5 L of a plasma expander
(iv) Proteinuria lower than 500 mg/day and no ultrasonographic evidence of obstructive uropathy or parenchymal renal disease
Additional criteria
Urine volume lower than 500 mL/day
Urine sodium lower than 10 mEq/L
Urine osmolality greater than plasma osmolality
Urine red blood cells less than 50 per high-power field
Serum sodium concentration lower than 130 mEq/L

All major criteria must be present for the diagnosis of hepatorenal syndrome. Additional criteria are not necessary for the diagnosis, but provide supportive evidence.