Major criteria for a diagnosis of hepatorenal syndrome
| (1) Chronic or acute liver disease with advanced hepatic failure and portal hypertension |
| (2) Low GFR, as indicated by serum creatinine >225 μM or creatinine clearance <40 ml/min |
| (3) Absence of shock, ongoing bacterial infection, or recent treatment with nephrotoxic drugs. Absence of excessive fluid losses (including gastrointestinal bleeding) |
| (4) No sustained improvement in renal function following expansion with 1.5 litres of isotonic saline |
| (5) Proteinuria <0.5 g/day, and no ultrasonagraphic evidence of renal tract disease |
| Additional criteria NOT required for diagnosis but commonly present |
| (1) Urine volume <500 ml/day |
| (2) Urine sodium <10 mM |
| (3) Urine osmolality >plasma osmolality |
| (4) Urine RBC <50 per high per field |
| (5) Serum sodium <130 mM |
GFR, glomerular filtration rate; RBC, red blood cells.