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Avoiding the V-word: Is volume therapy in hepatorenal syndrome killed by definition?
  1. A Umgelter,
  2. R M Schmid,
  3. W Huber
  1. II. Medizinische Klinik und Poliklinik der Technischen Universität München, Ismaningerstr. 22, 81644 München
    ; andreas.umgelter@lrz.tu-muenchen.de

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It is generally believed that the hepatorenal syndrome (HRS) is a functional kidney disorder resulting from a disturbed and hyperdynamic circulation leading to central hypovolaemia. Yet there seems to be a strong reluctance to regard it as amenable to volume resuscitation. In this context, the most striking change to the previous definition of HRS Type 1, proposed by the recent consensus workshop (Gut 2007;56:1310–8) is the inclusion among the diagnostic criteria of a failure to respond to plasma expansion with up to 1 g of albumin per kg body weight per day for 2 days. The amount itself is arbitrary and must result in a substantial, if not individually adjusted, increase in total plasma volume.

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