A 50-year-old man with alcoholic cirrhosis and tense ascites has serum creatinine rising from 1.0 to 2.6 mg/dL over two weeks. There is no shock, no recent nephrotoxic drug exposure, urine protein is negligible, ultrasound shows no obstruction, and creatinine does not improve after two days of albumin 1 g/kg/day with diuretic withdrawal. Urine sodium is 8 mEq/L. What is the recommended first-line pharmacological therapy?

• A Terlipressin combined with intravenous albumin ✓
• B Intravenous furosemide infusion
• C Low-dose oral midodrine alone
• D Intravenous hydrocortisone and saline loading

Explanation

This fulfils criteria for hepatorenal syndrome-AKI: cirrhosis with ascites, creatinine rise within 48 hours to 2 weeks, failure to improve after albumin and diuretic withdrawal, absence of shock and structural injury. Intense renal vasoconstriction from systemic vasodilatation drives the syndrome, so a vasopressin analogue such as terlipressin together with albumin is standard first-line therapy. Midodrine alone is weaker and used 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.