Last reviewed: 16 Aug 2024
Last updated: 20 Jun 2023
Summary
Definition
History and exam
Key diagnostic factors
- advanced cirrhosis
- jaundice
- ascites
Full details
Other diagnostic factors
- moderate lowering of BP
- peripheral edema
- hepatosplenomegaly
- spider angioma
- oliguria
- bruising
- petechiae
- palmar erythema
- scratch marks
- gynecomastia
- encephalopathy
- pruritus
- confusion
- drowsiness
Full details
Risk factors
- advanced cirrhosis
- ascites
- alcoholic hepatitis
- acute liver failure
- hyponatremia
- high plasma renin activity (PRA)
- spontaneous bacterial peritonitis
- large volume paracentesis
- gastrointestinal (GI) bleeding
- salt restriction
Full details
Diagnostic tests
1st tests to order
- creatinine
- BUN
- electrolytes
- CBC
- LFTs
- coagulation study
- diagnostic paracentesis and culture of ascitic fluid
- blood culture
- urinalysis and culture
- Chest x-ray
Full details
Tests to consider
- renal ultrasound
Full details
Treatment algorithm
INITIAL
spontaneous bacterial peritonitis (SBP): prevention of HRS
alcoholic hepatitis: prevention of HRS
suspected HRS
ACUTE
confirmed HRS-AKI
Contributors
Authors
John Kepros, MD
Trauma Medical Director
HonorHealth Osborn Hospital
Scottsdale
AZ
Disclosures
JK declares that he has no competing interests.
Peer reviewers
Howard J. Worman, MD
Professor of Medicine and Cell Biology
Columbia University College of Physicians and Surgeons
New York
NY
Disclosures
HJW declares that he has no competing interests.
George Y. Wu, MD, PhD
Professor of Medicine
University of Connecticut Health Center
Farmington
CT
Disclosures
GYW is on the medical advisory boards of the following: Gilead Sciences, Bristol-Myers Squibb, AbbVie, and Intercept.
Differentials
- Prerenal azotemia
- Acute tubular necrosis - ischemic
- Acute tubular necrosis - nephrotoxic
More DifferentialsGuidelines
- Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome
- EASL clinical practice guidelines for the management of patients with decompensated cirrhosis
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