A 58-year-old man with alcoholic cirrhosis and tense ascites has serum creatinine rising from 0.9 to 2.4 mg/dL over 8 days. Urine protein is negligible, urinary sediment is bland, and bilateral hydronephrosis is excluded. After two days of albumin 1 g/kg/day there is no improvement; he is normotensive and has received no nephrotoxins. Which intervention offers proven survival benefit?

• A Midodrine plus octreotide as definitive therapy
• B Terlipressin combined with intravenous albumin ✓
• C Furosemide challenge to exclude volume overload
• D Transjugular intrahepatic portosystemic shunt insertion

Explanation

This is hepatorenal syndrome-acute kidney injury: creatinine doubling above baseline within 48 hours to more than 2 mg/dL, failure of 2 days of diuretic withdrawal with albumin 1 g/kg, absence of shock or structural kidney disease. Terlipressin with albumin is the only medical therapy shown to reverse HRS and improve survival. TIPS is contraindicated in advanced disease and midodrine-octreotide is inferior.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.