A 50-year-old man with alcoholic cirrhosis develops ascites and spontaneous bacterial peritonitis. Despite volume resuscitation with albumin and withdrawal of diuretics, serum creatinine rises from 0.9 to 2.6 mg/dL over 12 days. Urinalysis is bland, urine sodium is very low, and sepsis has been treated. Which drug is now recommended as first-line therapy for this condition?

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

Explanation

This is hepatorenal syndrome-acute kidney injury: AKI in advanced cirrhosis that persists despite albumin and withdrawal of diuretics, with bland urine and intense renal vasoconstriction. Terlipressin, a vasopressin V1 agonist that reverses splanchnic vasodilatation, combined with albumin is the recommended first-line therapy and improves reversal of HRS-AKI. Noradrenaline is used when terlipressin is unavailable, not as monotherapy, and diuretics worsen renal perfusion.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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