A 50-year-old man with alcoholic cirrhosis and tense ascites has a creatinine rise from 1.1 to 2.6 mg/dL over two weeks. Urine sodium is 6 mEq/L, urine sediment is bland, there is no shock or recent nephrotoxin exposure, and creatinine does not improve after two days of albumin withdrawal of diuretics and volume expansion. Which therapy has shown survival benefit for this condition?

• A Oral spironolactone dose escalation
• B Intravenous furosemide infusion
• C Terlipressin combined with intravenous albumin ✓
• D Intravenous hydrocortisone

Explanation

This is hepatorenal syndrome-AKI, defined by cirrhosis with ascites, creatinine rise within 48 hours, lack of response to albumin challenge, and exclusion of shock and nephrotoxins. Terlipressin, a vasopressin V1 analogue, reverses splanchnic vasodilatation and, combined with albumin, improves reversal of HRS and transplant-free survival compared with placebo in randomised trials. Diuretic escalation worsens intravascular depletion and is contraindicated once HRS is established.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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