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Table 3 International Ascites Club (IAC) definition and diagnostic criteria for hepatorenal syndrome

From: Hepatorenal syndrome: the 8th international consensus conference of the Acute Dialysis Quality Initiative (ADQI) Group

1996 Criteria[39]

   Major Criteria

   • Chronic or acute liver disease with advanced hepatic failure and portal hypertension.

   • Serum creatinine > 1.5 mg/dL or 24-h creatinine clearance of < 40 mL/min.

   • Absence of shock, ongoing bacterial infection, and current or recent treatment with nephrotoxic drugs. Absence of gastrointestinal fluid losses (repeated vomiting or intense diarrhea) or renal fluid losses

   • No sustained improvement in renal function defined as a decrease in serum creatinine to < 1.5 mg/dL or increase in creatinine clearance to 40 mL/min or more following diuretic withdrawal and expansion of plasma volume with 1.5 L of isotonic saline.

   • Proteinuria < 500 mg/dL and no ultrasonographic evidence of obstructive uropathy or parenchymal renal disease.

   Minor Criteria

   • Urine volume < 500 mL/d

   • Urine sodium < 10 mEq/L

   • Urine osmolality > plasma osmolality

   • Urine red blood cells < 50 per high power field

2007 Criteria[40]

   • Cirrhosis with ascites

   • Serum creatinine > 1.5 mg/dL

   • No improvement of serum creatinine (decrease to a level ≤ 1.5 mg/dL) after at least two days of diuretic withdrawal and volume expansion with albumin. The recommended dose of albumin is 1 g/kg of body weight per day up to a maximum of 100 g/day

   • Absence of shock

   • No current or recent treatment with nephrotoxic drugs

   • Absence of parenchymal kidney disease as indicated by proteinuria > 500 mg/day, microhematuria (> 50 red blood cells per high power field), and/or abnormal renal ultrasonography