A 50-year-old man with decompensated alcoholic cirrhosis and ascites is admitted with creatinine rising from 0.9 to 2.6 mg/dL over 10 days. He has no shock, no recent nephrotoxic drug exposure, and no response to 2 days of albumin 1 g/kg/day plus volume withdrawal. Urine protein is negligible and ultrasound shows no obstruction. What is the recommended pharmacological therapy?

• A Furosemide plus spironolactone up-titration
• B Dopamine infusion for renal protection
• C Noradrenaline alone via central line
• D Terlipressin plus albumin ✓

Explanation

These are the International Club of Ascites criteria for hepatorenal syndrome-AKI: cirrhosis with ascites, creatinine rise, lack of improvement after diuretic withdrawal and albumin expansion, and exclusion of shock, nephrotoxins, parenchymal disease, and obstruction. The recommended therapy is a vasoconstrictor (terlipressin, or noradrenaline where terlipressin is unavailable) combined with albumin. Diuretics are stopped, not increased. Low-dose dopamine has no benefit in hepatorenal syndrome.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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