A 55-year-old man with decompensated alcoholic cirrhosis and tense ascites develops progressive oliguria and rising creatinine over 2 weeks. Urine sodium is 8 mEq/L, urine osmolality 520 mOsm/kg, and no proteinuria on dipstick. Ultrasound shows normal kidneys without obstruction. Which is the most appropriate pharmacologic therapy?

• A Intravenous furosemide
• B Oral spironolactone
• C IV terlipressin with albumin ✓
• D IV norepinephrine alone

Explanation

This patient meets criteria for hepatorenal syndrome type 1 (rapid doubling of creatinine, low urine sodium, no obstruction, no nephrotoxic drugs). First-line pharmacologic therapy is terlipressin (a vasopressin analog) combined with albumin. Norepinephrine plus albumin is an alternative when terlipressin is unavailable. Diuretics are contraindicated as they worsen renal perfusion in this setting.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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