A 55-year-old man with alcoholic cirrhosis and ascites develops AKI over one week: creatinine rises from 1.1 to 2.6 mg/dL. Urine output is 400 mL/day, urine sodium 8 mEq/L, no response to albumin challenge (1 g/kg for 2 days) or diuretic withdrawal. No shock or nephrotoxic drug exposure. Which single agent is now standard first-line therapy for this condition?

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

Explanation

This is hepatorenal syndrome-AKI by ICA criteria: cirrhosis with ascites, creatinine rise, no response to diuretic withdrawal and albumin expansion, absence of shock. The splanchnic vasodilatation of portal hypertension reduces effective arterial volume; terlipressin, a vasopressin V1 agonist, reverses it and combined with albumin improves reversal rates and survival versus placebo. Low-dose dopamine is renoprotective in name only and has no role. Noradrenaline is an alternative only where terlipressin is unavailable.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.