Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The process evaluates potential cases of hepatorenal syndrome-acute kidney injury using six specific diagnostic criteria. Each criterion presents a requirement that must be addressed:

- Diagnosis of liver cirrhosis and ascites
- Diagnosis of acute kidney injury, noted by an increase in serum creatinine either by 0.3 mg/dL (26.5 µmol/L) within 48 hours or by 50% from the baseline, occurring over the last 7 days
- Lack of response after two consecutive days of diuretic withdrawal and plasma volume expansion with albumin at a dosage of 1 g/kg/day
- Absence of shock
- No current or recent usage of nephrotoxic drugs, like nonsteroidal anti-inflammatory drugs, aminoglycosides, or iodinated contrast media
- No signs of structural kidney injury, such as proteinuria over 500 mg/day, microhematuria exceeding 50 red blood cells per high-power field, and/or abnormal renal ultrasound results

For the diagnosis of hepatorenal syndrome-acute kidney injury to be confirmed, all criteria must be fulfilled. If all conditions are met, the result is "Diagnostic criteria are met". If one or more of these are not satisfied, the output is "Diagnostic criteria are not met". This structured approach ensures that only patients meeting comprehensive criteria are recognized under this diagnosis, which could guide corresponding medical interventions.

The Revised International Club of Ascites (ICA) diagnostic criteria for hepatorenal syndrome-acute kidney injury (HRS-AKI) is a clinical calculator used in the diagnosis of HRS-AKI in patients with cirrhosis and ascites. This scoring system is specifically designed for patients with liver cirrhosis who have developed ascites, a condition characterized by the accumulation of fluid in the peritoneal cavity, and are suspected of having hepatorenal syndrome, a type of kidney failure that occurs in individuals with severe liver disease. 

The clinical utility of this calculator is to aid in the early and accurate diagnosis of HRS-AKI, which is crucial for the initiation of appropriate treatment and management strategies. The Revised ICA diagnostic criteria for HRS-AKI takes into account factors such as the absence of shock, no current or recent treatment with nephrotoxic drugs, and no signs of parenchymal kidney disease.

Exclusion criteria for the use of this calculator include patients without cirrhosis and ascites, those with shock, those who have been treated with nephrotoxic drugs, and those showing signs of parenchymal kidney disease.

Hepatorenal syndrome

Background

Overview

Guidelines

Key sources