Table 3.

Diagnostic criteria of hepatorenal syndromea

aAll major criteria must be present for the diagnosis of hepatorenal syndrome. Additional criteria are not necessary for the diagnosis, but provide supportive evidence.
Major criteria
  • low glomerular filtration rate, as indicated by serum creatinine >1.5 mg/dl or 24-h creatinine clearance <40 ml/min.

  • absence of shock, ongoing bacterial infection, fluid loss, and current treatment with nephrotoxic drugs.

  • no sustained improvement in renal function (decrease in serum creatinine to 1.5 mg/dl or less or increase in creatinine clearance to 40 ml/min or more) following diuretic withdrawal and expansion of plasma volume with 1.5 L of a plasma expander.

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

Additional criteria
  • urine volume <500 ml/d.

  • urine sodium <10 mEq/L.

  • urine osmolality greater than plasma osmolality.

  • urine red blood cells <50 per high power field.

  • serum sodium concentration <130 mEq/L.