Major criteria

1. Low glomerular filtration rate, as indicated by serum creatinine greater than 1.5 mg/dl or 24-hour creatinine clearance lower than 40 ml/minute

2. Absence of shock, ongoing bacterial infection, fluid losses and current treatment with nephrotoxic drugs

3. No sustained improvement in renal function (decrease in serum creatinine to 1.5 mg/dl or less or increase in creatinine clearance to 40 ml/minute or more) following diuretic withdrawal and expansion of plasma volume with 1.5 l of a plasma expander

4. Proteinuria lower than 500 mg/day and no ultrasonographic evidence of obstructive uropathy or parenchymal renal disease

Additional criteria

1. Urine volume lower than 500 ml/day

2. Urine sodium lower than 10 mEq/l

3. Urine osmolality greater than plasma osmolality

4. Urine red blood cells less than 50 per high-power field

5. Serum sodium concentration lower than 130 mEq/l

All major criteria must be present for the diagnosis of hepatorenal syndrome. Additional criteria are not necessary for the diagnosis, but provide supportive evidence.

 

 

Clinical types of hepatorenal syndrome

  

Type I: Rapid and progressive impairment of renal function as defined by a doubling of the initial serum creatinine to a level higher than 2.5 mg/dl or a 50% reduction of the initial 24-hour creatinina clearance to a level lower than 20 ml/minute in less than 2 weeks

Type II: Impairment in renal function (serum creatinine 41.5 mg/dl) that does not meet the criteria of type I

 

References:

1. Gines P. Diagnosis and treatment of hepatorenal syndrome. Baillieres Best Pract Res Clin Gastroenterol. 2000 Dec;14(6):945-57. [Medline]