ICU Map

Hepatorenal Syndrome–AKI ICU Pathway

Diagnosis and ICU management of HRS-AKI with albumin, vasoconstrictors, respiratory-safety monitoring, RRT and transplant planning

RecognizeAssessDecideDifferentialInterveneReassess
Hepatorenal Syndrome–AKI
Assessment StepStabilize physiology and identify the reversible driverExplore Topic
In cirrhosis with ascites and AKI, assess infection, bleeding, hypovolemia, nephrotoxins, obstruction and structural kidney injury. Urine sodium/FENa are often low in cirrhosis and do not reliably distinguish HRS from other causes.
Clinical ActionDeliver disease-specific therapy and source control
Terlipressin plus albumin can reverse HRS-AKI in selected patients. Norepinephrine is an effective ICU alternative requiring titration and monitoring. Midodrine plus octreotide is generally less effective when these options are available.

An educational representation of clinical reasoning, not a diagnostic algorithm or personalized medical advice — always apply clinical judgment and institutional protocols.

Caution

Escalate — Red Flags & Critical Warnings

  • Do not allow diagnostic testing to delay immediate stabilization or time-critical definitive therapy.

Related Bedside Clinical Problems (1)

Bedside Presentations
Cirrhosis with Progressive AKI / Suspected HRS-AKI

Exclude reversible/structural causes, treat precipitating infection or volume loss, then use albumin plus an appropriate vasoconstrictor while monitoring respiratory safety and transplant candidacy.

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Linked Deep-Dive Topics (1)

Reference Knowledge
Hepatorenal Syndrome–AKIgi-hepatic

Diagnosis and ICU management of HRS-AKI with albumin, vasoconstrictors, respiratory-safety monitoring, RRT and transplant planning

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Evidence status

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