A 38-year-old man with cirrhosis develops acute ascites decompensation. Diagnostic paracentesis shows SAAG 1.8 g/dL, total protein 1.5 g/dL, cell count 380 cells/µL with 75% neutrophils. Serum creatinine rises from 0.9 to 2.6 mg/dL over 48 hours. Which management is proven to prevent HRS and reduce mortality in this context?

• A IV albumin 1.5 g/kg on day 1 and 1 g/kg on day 3 plus IV cefotaxime ✓
• B IV noradrenaline plus IV albumin 20 g/day
• C Terlipressin alone without albumin in hepatitis B cirrhosis
• D Midodrine plus octreotide orally with albumin 20 g after each large volume paracentesis

Explanation

This patient has spontaneous bacterial peritonitis (SBP: PMN ≥250/µL) with acute kidney injury (likely HRS type 1). The landmark Sort et al. (NEJM 1999) trial demonstrated that IV albumin (1.5 g/kg at diagnosis + 1 g/kg on day 3) combined with antibiotics (cefotaxime) significantly reduced incidence of renal impairment (10% vs 33%) and in-hospital mortality (10% vs 29%). This remains standard of care. Terlipressin plus albumin is used for established HRS-AKI (type 1 HRS) but evidence specifically in SBP setting is for albumin plus antibiotics combination.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.