The International Ascites Club developed criteria for the hepatorenal syndrome.

Patient selection: liver disease with cirrhosis and ascites


Major criteria:

(1) low glomerular filtration rate (GFR), with either serum creatinine > 132 µmol/L or creatinine clearance < 40 mL per minute

(2) absence of shock, nephrotoxin, fluid loss, ongoing infection

(3) no improvement with volume expansion

(4) proteinuria < 500 mg per day, and/or normal renal ultrasound


Minor criteria:

(1) 24 hour urine volume < 500 mL per day

(2) urine sodium < 10 mEq/L

(3) urine osmolality > plasma osmolality

(4) urine RBC < 50 per high power field (HPF)

(5) serum sodium < 130 mEq/L


Watt et al said that a person had the hepatorenal syndrome if:

(1) the first 3 major criteria were present, AND

(2) one of the following:

(2a) both proteinuria < 500 mg/day AND normal ultrasound

(2b) if one or both of these tests was not done, then 3 of the minor criteria



• According to the wording, it would appear that either a proteinuria >= 500 mg/day or an abnormal ultrasound would not support the diagnosis of the hepatorenal syndrome.

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