Diagnosis of hepatorenal syndrome

ATN: acute tubular necrosis; KDIGO: Kidney Disease: Improving Global Outcomes.
* Acute kidney injury is defined in this context as an increase in serum creatinine ≥0.3 mg/dL within 48 hours or ≥50% within 7 days; this is consistent with KDIGO criteria.
¶ Refer to UpToDate content on the evaluation of patients with acute kidney injury.
Δ Evidence for a alternative etiology of acute kidney injury makes hepatorenal syndrome less likely (hepatorenal syndrome is generally a diagnosis of exclusion). However, such patients may also have superimposed hepatorenal syndrome as a second disorder.
◊ Unexpected clinical course indicates that management of presumed etiology did not result in the expected outcome (eg, worsening kidney function despite relief of diagnosed urinary tract obstruction, failure of contrast-associated injury to resolve in the anticipated timeline, etc).
§ This disorder is referred to as hepatorenal syndrome with acute kidney injury (HRS-AKI) by some experts; other experts refer to this entity as type 1 hepatorenal syndrome.