A 55-year-old man with alcoholic cirrhosis and tense ascites develops acute kidney injury. He is not in shock, and he has taken no nephrotoxic drugs. Urine sodium is 8 mmol/L, and urinalysis shows no proteinuria or hematuria. Diuretics are withdrawn and intravenous albumin is administered for 48 hours, but serum creatinine continues to rise. What is the most likely diagnosis?
- A Hepatorenal syndrome ✓
- B Acute tubular necrosis
- C Prerenal azotemia
- D Drug-induced interstitial nephritis
Correct answer: A. Hepatorenal syndrome
Explanation
Hepatorenal syndrome is diagnosed when acute kidney injury fails to improve after diuretic withdrawal and albumin expansion in a cirrhotic patient without shock, nephrotoxic drugs, or intrinsic renal disease. Prerenal azotemia would improve with volume expansion. Acute tubular necrosis typically presents with elevated urine sodium and granular casts. Interstitial nephritis often shows eosinophiluria and pyuria.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.