Hepatorenal Syndrome (HRS)

Diagnosis and Management of Hepatorenal Syndrome (HRS)
Diagnosis Consider HRS in PLWH with cirrhosis and ascites and a creatinine level of > 1.5 mg/dL. It is a diagnosis of exclusion - before making the diagnosis, the following need to be ruled out and treated:
  • Sepsis (person needs to be pancultured)
  • Volume depletion (haemorrhage, diarrhoea, overdiuresis)
  • Vasodilatators
  • Organic renal failure (urine sediment; kidney ultrasound)
Diuretics should be discontinued and intravascular volume expanded with iv albumin. If renal dysfunction persists despite above, diagnose HRS
Recommended therapy Liver transplant (priority dependent on MELD score, see Liver Cirrhosis: Management). If the person is on transplant list, MELD score should be updated daily and communicated to transplant centre, see Solid Organ Transplantation (SOT) in PLWH
Alternative (bridging therapy) Vasoconstrictors Octreotide 100-200 µg sc tid
→ Goal to increase mean arterial pressure by 15 mmHg
+ Midodrine 5-15 mg po tid
or terlipressin 0.5-2 mg iv every 4-6h
and iv albumin
(both for at least 7 days)
  50-100 g IV qd