Treatment of Hepatorenal Syndrome (HRS-AKI)

Hepatorenal syndrome with acute kidney injury (HRS-AKI) is characterised by rapidly worsening kidney function in the setting of advanced liver disease. Management is directed at reversing kidney impairment within a defined response window.

Treatment Approach

The evidence-based treatment for HRS-AKI is vasoconstrictor therapy in combination with albumin, supported by multiple randomised controlled trials and meta-analyses. The full structured regimen — including agent selection, escalation criteria, and the complete dosing protocol — is available via the button below.

Response Target

Treatment response is defined as serum creatinine decreasing to below 1.5 mg/dL, or returning to within 0.3 mg/dL of baseline, over a maximum of 14 days.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1002/hep.31884

Several randomized controlled trials and meta-analyses have shown that vasoconstrictors, either terlipressin or norepinephrine, in combination with albumin are effective in improving kidney function in patients with HRS-AKI, with the response rate of 20%–80% (average ~50%).
The treatment of choice for HRS-AKI is vasoconstrictor drugs in combination with albumin.
Response to terlipressin or norepinephrine is defined by creatinine decreases to <1.5 mg/dL or return to within 0.3 mg/dL of baseline over a maximum of 14 days.

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