A 55-year-old man with HCV cirrhosis develops hepatorenal syndrome type 1 (HRS-AKI) — serum creatinine rises from 0.9 to 2.8 mg/dL in 48 hours without response to 2 days of albumin. Urine sodium is 8 mEq/L. Which vasopressor therapy combined with albumin is the standard medical bridge therapy in HRS-AKI?
- A Terlipressin + albumin (20-40 g/day) ✓
- B Dopamine (low-dose 'renal dose') + furosemide
- C Norepinephrine alone — albumin infusion not necessary if BP maintained
- D Midodrine + octreotide + albumin — equivalent to terlipressin in all settings
Explanation
Hepatorenal syndrome type 1 (HRS-AKI) is treated with the vasopressin analogue terlipressin (splanchnic vasoconstrictor) combined with albumin (20-40 g/day) as the evidence-based pharmacological bridge to liver transplantation. Terlipressin improves renal blood flow by reducing splanchnic vasodilation and portal hypertension. It has Level 1A evidence per EASL guidelines. Midodrine + octreotide + albumin is used where terlipressin is unavailable (mainly in the US historically) but is considered inferior. Low-dose dopamine has no proven benefit and is no longer recommended.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.