From the Guidelines
Furea (furosemide) is not used to diagnose hepatorenal syndrome (HRS). The diagnosis of HRS relies on specific diagnostic criteria including the presence of cirrhosis with ascites, acute kidney injury, absence of shock, no recent use of nephrotoxic drugs, no response to volume expansion with albumin, and exclusion of other causes of kidney injury. Furosemide is a loop diuretic that increases urine output by inhibiting sodium and chloride reabsorption in the kidneys, but it does not provide diagnostic information about HRS. In fact, diuretics like furosemide are typically discontinued when HRS is suspected because they can worsen kidney function in these patients, as noted in the management guidelines for liver cirrhosis and ascites 1.
The diagnostic approach for HRS involves laboratory tests to assess kidney function (creatinine, BUN), urinalysis to rule out intrinsic kidney disease, and often ultrasound to exclude obstructive causes. Treatment of HRS typically involves vasoconstrictors like terlipressin or norepinephrine combined with albumin, not furosemide. According to the guidelines for managing adult patients with ascites due to cirrhosis, first-line treatment consists of sodium restriction and diuretics (oral spironolactone and furosemide), but this is for managing ascites, not diagnosing HRS 1.
Key points to consider in the management of ascites and potential HRS include:
- The use of diuretics like furosemide in the treatment of ascites, but not in the diagnosis of HRS
- The importance of monitoring serum sodium levels and adjusting diuretic use accordingly to prevent complications like hyponatremia 1
- The role of vasoconstrictors and albumin in the treatment of HRS, rather than diuretics like furosemide
- The need for a comprehensive diagnostic approach to identify HRS, including laboratory tests and imaging studies.
In clinical practice, the focus should be on promptly identifying and managing HRS with appropriate treatments, rather than relying on diuretics like furosemide for diagnosis, as supported by the most recent guidelines on liver cirrhosis management 1.
From the Research
Diagnosis of Hepatorenal Syndrome
- Hepatorenal syndrome (HRS) is diagnosed when kidney function is reduced but evidence of intrinsic kidney disease, such as hematuria, proteinuria, or abnormal kidney ultrasonography, is absent 2
- The diagnosis of HRS is a challenge because of a lack of specific diagnostic tools and mainly involves the differential diagnosis from other forms of acute kidney injury (AKI), particularly acute tubular necrosis 3
- There is no mention of Furea being used to diagnose hepatorenal syndrome in the provided studies
Treatment and Management of Hepatorenal Syndrome
- The ideal treatment for HRS is liver transplantation in patients without contraindications 3
- Medical therapy consists of vasoconstrictor drugs to counteract splanchnic arterial vasodilation together with volume expansion with albumin 3
- A combination of midodrine, octreotide, and albumin has been shown to improve renal function in patients with type 1 HRS 4
- Transjugular intrahepatic portosystemic stent shunt (TIPS) is an effective treatment for type 1 HRS in suitable patients with cirrhosis and ascites, following the improvement of renal function with combination therapy of midodrine, octreotide, and albumin 4