A 55-year-old man with alcoholic cirrhosis and ascites develops acute kidney injury over 10 days. Creatinine rises from 1.2 to 3.4 mg/dL. Urine output is low. Urine sodium is 8 mEq/L. Urinalysis shows no proteinuria, no haematuria, and no casts. No recent nephrotoxins. No shock. Which diagnosis is MOST likely?
- A Prerenal azotaemia (hypovolemia)
- B Acute tubular necrosis
- C Hepatorenal syndrome type 1 ✓
- D Glomerulonephritis
Correct answer: C. Hepatorenal syndrome type 1
Explanation
HRS type 1 meets all IAC criteria: cirrhosis with ascites, AKI with creatinine doubling in <2 weeks, absence of shock, no nephrotoxins, no intrinsic kidney disease (no proteinuria/casts), and no response to volume expansion. Low urine sodium reflects intense sodium retention but does not distinguish HRS from prerenal state. Distractor A is ruled out by lack of response to diuretic withdrawal and albumin. Distractor B would have granular casts and higher FENa.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.