Table 3

International Ascites Club (IAC) definition and diagnostic criteria for hepatorenal syndrome

    1996 Criteria

Major Criteria

• Chronic or acute liver disease with advanced hepatic failure and portal hypertension.

• Serum creatinine > 1.5 mg/dL or 24-h creatinine clearance of < 40 mL/min.

• Absence of shock, ongoing bacterial infection, and current or recent treatment with nephrotoxic drugs. Absence of gastrointestinal fluid losses (repeated vomiting or intense diarrhea) or renal fluid losses

• No sustained improvement in renal function defined as a decrease in serum creatinine to < 1.5 mg/dL or increase in creatinine clearance to 40 mL/min or more following diuretic withdrawal and expansion of plasma volume with 1.5 L of isotonic saline.

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

Minor Criteria

• Urine volume < 500 mL/d

• Urine sodium < 10 mEq/L

• Urine osmolality > plasma osmolality

• Urine red blood cells < 50 per high power field

    2007 Criteria

• Cirrhosis with ascites

• Serum creatinine > 1.5 mg/dL

• No improvement of serum creatinine (decrease to a level ≤ 1.5 mg/dL) after at least two days of diuretic withdrawal and volume expansion with albumin. The recommended dose of albumin is 1 g/kg of body weight per day up to a maximum of 100 g/day

• Absence of shock

• No current or recent treatment with nephrotoxic drugs

• Absence of parenchymal kidney disease as indicated by proteinuria > 500 mg/day, microhematuria (> 50 red blood cells per high power field), and/or abnormal renal ultrasonography

Nadim et al. Critical Care 2012 16:R23   doi:10.1186/cc11188

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