In hepatorenal syndrome (HRS)

MAKE THE COUNT

Quickly connect the clues that
may point to an answer: HRS-AKI

WHAT IS HRS-AKI?

HRS-acute kidney injury (AKI), a complication of decompensated cirrhosis, is a functional, progressive failure of the kidneys that may be reversible but is often rapidly fatal.¹

Without treatment, median survival time is approximately 2 weeks.¹

HRS-AKI occurs when portal hypertension due to cirrhosis triggers vasodilation in the blood vessels that supply the splanchnic organs and in the systemic circulation. A reduction in effective circulatory blood volume and pressure results, triggering an overactivation of vasoconstrictor systems.^2,3

A byproduct of this compensatory response is renal vasoconstriction, which reduces renal blood flow and causes serious functional impairment, as evidenced by increased serum creatinine (SCr) levels.^2,3

HRS-AKI by the numbers

START WITH “CARE”

Look for these clues

HRS-AKI can present differently for each patient, but there are 4 clues to look for.²

CIRRHOSIS

ASCITES

RESISTANCE TO ALBUMIN

ELEVATED SERUM CREATININE

Use the complete criteria to confirm your suspicion

Once you suspect HRS-AKI, use the complete American Association for the Study of Liver Diseases (AASLD) Guidance criteria to help make a diagnosis.^2,a

Cirrhosis with ascites
Increase in SCr ≥0.3 mg/dL from baseline within 48 hours or ≥50% increase in SCr that is known or presumed to have occurred within the preceding 7 days^b
No improvement after 48 hours of diuretic withdrawal and volume expansion with albumin (1 g/kg body weight per day)
Absence of shock
No current or recent treatment with nephrotoxic drugs (nonsteroidal anti-inflammatory drugs, aminoglycosides, or iodinated contrast media)
No signs of structural kidney injury, as indicated by proteinuria (>500 mg per day), microhematuria (>50 red blood cells per high-power field), and/or abnormal renal ultrasonography

HRS-AKI is an acute condition that often becomes fatal.¹
AASLD Guidance is clear: Early diagnosis and intervention is the goal.² More guidance for diagnosing HRS-AKI is available from AASLD.^c

You are advised to use your own medical judgment in making patient-specific decisions.

^bStable SCr values within the previous 3 months prior to hospitalization may be used as the baseline. However, if a previous creatinine before admission is not available, a diagnosis of AKI can only be made if SCr continues to rise during hospitalization.²

^chttps://www.aasld.org/practice-guidelines/diagnosis-evaluation-and-management-ascites-spontaneous-bacterial-peritonitis.

With early diagnosis, improved outcomes are possible

Pixelated image of female patient with HRS-AKI fading

HRS-AKI results in a rapid decline in kidney function. The longer it remains untreated, the more likely it is to become irreversible.¹

A liver transplant is the only curative treatment for underlying cirrhosis that leads to HRS-AKI.¹ Regardless of a patient’s eligibility for liver transplant, pharmacological treatments are utilized to help improve renal function.² Pharmacological response has been shown to be greatest when administered early.^8,9

Whether referring or treating, make the hours count by acting early

STAY INFORMED

Being aware of the latest HRS-AKI updates is key when diagnosing patients. Sign up to receive resources, tips, and more.

*Required fields.

First name*

This is a required field.

Last name*

This is a required field.

Professional email address*

This is a required field.

Zip code*

This is a required field.

Specialty

Have you treated HRS-AKI before?

Yes, I would like to opt in to receive future Mallinckrodt communications.

Opt-in is required.

By selecting submit, I agree to these Terms of Use and Privacy Policy. I also hereby consent to Mallinckrodt Pharmaceuticals (“Mallinckrodt”), through its third-party designees or directly, using my information to send me communications regarding Mallinckrodt-sponsored information on products and educational programs that may be of interest to me. I understand that Mallinckrodt and its designees will not sell, transfer to, or otherwise share my information with any third party except as set forth in Mallinckrodt’s Privacy Policy located at www.mallinckrodt.com/privacy-policy. At any time, I can stop receiving communications from Mallinckrodt by clicking the “unsubscribe” link at the bottom of future emails.

References: 1. Flamm SL, Brown K, Wadei HM, et al. Liver Transpl. 2021;27(8):1191-1202. doi:10.1002/lt.26072 2. Biggins SW, Angeli P, Garcia-Tsao G, et al. Hepatology. 2021;74(2):1014-1048. doi:10.1002/hep.31884 3. Ginès P, Solà E, Angeli P, Wong F, Nadim MK, Kamath PS. Nat Rev Dis Primers. 2018;4(1):23. doi:10.1038/s41572-018-0022-7 4. Pant C, Jani BS, Desai M, et al. J Investig Med. 2016;64(1):33-38. doi:10.1136/jim-d-15-00181 5. QuickFacts: United States. US Census Bureau; 2021. https://www.census.gov/quickfacts/US 6. Suneja M, Tang F, Cavanaugh JE, Polgreen LA, Polgreen PM. Int J Nephrol. 2016;2016:1-6. doi:10.1155/2016/8419719 7. Singh J, Dahiya DS, Kichloo A, Singh G, Khoshbin K, Shaka H. Ann Med. 2021;53(1):2018-2024. doi:10.1080/07853890.2021.1998595 8. Angeli P, Ginès P, Wong F, et al. Gut. 2015;64(4):531-537. doi:10.1136/gutjnl-2014-308874 9. Curry MP, Vargas HE, Befeler AS, Pyrsopoulos NT, Patwardhan VR, Jamil K. Hepatol Commun. 2023;7(1):e1307. doi:10.1097/01.HC9.0000897228.91307.0c