A 58-year-old woman with Child-Pugh C cirrhosis and ascites has serum creatinine rising from 0.8 to 2.4 mg/dL over 10 days. Diuretics were stopped and albumin 1 g/kg daily was given for 48 hours without improvement. Urine protein is negligible, urine sediment is bland, no shock or nephrotoxic drugs, renal ultrasound normal. What is the best treatment?

• A Furosemide 80 mg intravenously twice daily
• B Haemodialysis as definitive therapy
• C Norfloxacin 400 mg twice daily
• D Terlipressin plus albumin 20 to 40 g daily ✓

Explanation

This fulfills criteria for hepatorenal syndrome AKI: cirrhosis with ascites, creatinine rise meeting AKI definition, no response to 48 hours of albumin after diuretic withdrawal, and absence of shock, nephrotoxins, or structural renal disease. Terlipressin combined with albumin reverses HRS in about 40 percent of cases and improves transplant-free survival. Furosemide worsens intravascular depletion. Dialysis is a bridge to transplant, not definitive therapy, and antibiotics address SBP, which is not present here.

Reference: Sherlock's Diseases of the Liver and Biliary System, 13th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.