A 55-year-old man with decompensated alcoholic cirrhosis and refractory ascites develops acute kidney injury. Serum creatinine rises from 1.2 to 3.1 mg/dL over 5 days. Urine sodium is 8 mEq/L, urinalysis shows no proteinuria, and renal ultrasound is normal. Which is the most appropriate first-line pharmacologic treatment?

• A Terlipressin with albumin ✓
• B Dopamine infusion
• C Furosemide infusion
• D Hemodialysis

Explanation

This presentation is consistent with hepatorenal syndrome type 1, defined as rapid progressive AKI in cirrhosis without another cause. Terlipressin (a vasopressin analog) combined with albumin is first-line pharmacotherapy, acting by splanchnic vasoconstriction to improve effective arterial blood volume. Furosemide and dopamine are ineffective. Hemodialysis is reserved for patients not responding to vasoconstrictors.

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

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Written and medically reviewed by the StethoPrep medical team.