Hepatorenal syndrome is characterized by all of the following except: March 2005
Ans. B: Managed effectively by renal vasodilating agents. HRS is defined as worsening azotemia with avid sodium retention and oliguria in the absence of identifiable specific cause of renal dysfucntion in setting of acute or advanced chronic liver disease No specific tests establish the diagnosis of HRS. Diagnosis of HRS is based on the presence of a reduced GFR in the absence of other causes of renal failure in patients with chronic liver disease. The following criteria help to diagnose HRS: Major criteria: All major criteria are required to diagnose HRS. Low GFR, indicated by a serum creatinine level higher than 1.5 mg/ dL or 24-hour creatinine clearance lower than 40 mL/ min Absence of shock, ongoing bacterial infection and fluid losses, and current treatment with nephrotoxic medications No sustained improvement in renal function (decrease in serum creatinine to40 mL/ min) after diuretic withdrawal and expansion of plasma volume with 1.5 L of plasma expander Proteinuria less than 500 mg/ d and no ultrasonographic evidence of obstructive uropathy or intrinsic parenchymal disease Additional criteria: Additional criteria are not necessary for the diagnosis but provide suppoive evidence. Urine volume less than 500 mL/d Urine sodium level less than 10 mEq/ L Urine osmolality greater than plasma osmolality Urine red blood cell count of less than 50 per high-power field Serum sodium concentration less than 130 mEq/ L The best therapy for HRS is liver transplantation.
Reduction in creatinine clearance
Managed effectively by renal vasodilating agents.
Proteinuria less than 500 mg/ d
Normal intrinsic kidney