How is hepatorenal syndrome diagnosed in cirrhosis?

Updated: Oct 15, 2020
  • Author: David C Wolf, MD, FACP, FACG, AGAF, FAASLD; Chief Editor: BS Anand, MD  more...
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Hepatorenal syndrome is diagnosed when a creatinine clearance rate of less than 40 mL/min is present or when a serum creatinine level of greater than 1.5 mg/dL, a urine volume of less than 500 mL/day, and a urine sodium level of less than 10 mEq/L are present. [1] Urine osmolality is greater than plasma osmolality.

In hepatorenal syndrome, renal dysfunction cannot be explained by preexisting kidney disease, prerenal azotemia, the use of diuretics, or exposure to nephrotoxins. Clinically, the diagnosis may be reached if the central venous pressure is determined to be normal or if no improvement in renal function occurs following the infusion of at least 1.5 L of a plasma expander.

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