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
where:
• 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.
