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