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Pre renal^
azotemia

Hepatorenal

syndrome

Acute tubular
Necrosis
Urinary sodium
(mmol/L)

<10 <10 >20

Urine/plasma
creatinine ratio

>30/1 >20/1 <20/1

Urine osmolarity
(mosmol/l)

≥200 higher than

plasma

>200 higher

than plasma

Relatively similar to

plasma (isothenuric)

Urine sediment Normal Unremarkable Casts, cellular debris

Treatment of Hepatorenal Syndrome

• Treatment of HRS is largely supportive.


• Prevention is more important. Toxic agents as NSAIDs,
  demeclocycline, aggressive diuresis or aggressive paracentesis have to
  be avoided.


• If azotaemia is discovered in hepatic patient, the precipitating factor as
  volume contraction, cardiac decompensation and urinary tract
  obstruction have to be discovered and promptly treated.


• If prerenal azotemia is possible we have to give a volume expander
  (colloid as albumin or crystalloid as saline).


• Abdominal paracentesis with plasma volume expansion (e.g. by salt
  free albumin) may decrease the intra-abdominal pressure, decrease