Hepatorenal Syndrome and Its Diagnosis Criteria – Major and Additional

Hepatorenal Syndrome is defined as a state of functional renal failure (Reduced GFR) in patients with severe liver disease.
Structurally/Histologically the kidneys are normal and recover function after successful liver transplantation.[MCQ]
Pathogenetic hallmark of hepatorenal syndrome is intense renal vasoconstriction with systemic vasodilation.
The diagnosis of hepatorenal syndrome is based according to following diagnostic criteria.

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Diagnosis criteria of Hepatorenal Syndrome

For diagnosis of hepatorenal syndrome there are some: Major points [all points must be fulfilled to make diagnosis of Hepatorenal syndrome]

There are some additional points also which supports the diagnosis of Hepatorenal syndrome which all are not neccessary to be present.

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Low Glomerular filteration rate, as indicated by serum creatinine >1.5mg/dl or 24 hr creatinine clearance <40ml/min
Absence of shock, ongoing bacterial infection, fluid losses, and current treatment with nephrotoxic drugs.
No sustaned improvement in renal function (measured bydecrease in serum creatitnine to 1.5 on increase in creatinine clearance to 40 ml/min) after diuretic withdrawal and expansion of plasma volume witg 1.5 ltr. of plasma expander.
Proteinuria <500mg/dl and no ultrasonographic evidence of obstructive uropathy or parenchymal renal disease.