A 46-year-old woman with cirrhosis and tense ascites develops progressive azotaemia over 10 days. Creatinine rose from 0.9 to 2.8 mg/dL. She is haemodynamically stable, has received albumin 1 g/kg daily for two days without improvement, has not received nephrotoxic drugs, and urinalysis is bland. Which agent, given with albumin, is first-line therapy?

• A Terlipressin ✓
• B Noradrenaline
• C Midodrine alone
• D Octreotide

Explanation

This patient fulfils criteria for hepatorenal syndrome-AKI: cirrhosis with ascites, creatinine rise over days to weeks, no response to two days of albumin, absence of shock and nephrotoxins, and bland urine. The pathophysiology is intense splanchnic vasodilatation with renal vasoconstriction, so a splanchnic vasoconstrictor combined with plasma volume expansion reverses it. Terlipressin plus albumin improves reversal of HRS-AKI and is first-line. Midodrine and octreotide are inferior alternatives used only when terlipressin is unavailable.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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