No improvement of serum creatinine (decrease to a level of ⩽133 μmol/l) after at least 2 days with diuretic withdrawal and volume expansion with albumin. The recommended dose of albumin is 1 g/kg of body weight per day up to a maximum of 100 g/day.
Absence of shock
No current or recent treatment with nephrotoxic drugs
Absence of parenchymal kidney disease as indicated by proteinuria >500 mg/day, microhaematuria (>50 red blood cells per high power field) and/or abnormal renal ultrasonography
Classifications
Type 1
Acute onset within 2 weeks of a precipitating factor for decompensated liver disease
Usual triggers are severe alcoholic hepatitis and spontaneous bacterial peritonitis
Type 2
Slowly-progressive renal failure in the context of refractory ascites
Often with sodium retention
Can progress into type 1 HRS
Management
Type 1
Rule out other causes
Stop diuretics unless needed for management of volume status
Albumin 1 g/kg body weight for 2 days followed by 20-40 g/day until 14 days or complete respond
+/- octreotide 100 mcg SC three times daily and midodrine 7.5 mg p.o. three times daily
Terlipressin (a vasopressin analogue) is probably better than octreotide and midodrine but not widely available
