International Ascites Club Diagnostic Criteria for Hepatorenal Syndrome

Major Criteria

     Chronic or acute hepatic disease and liver failure with portal hypertension

     Serum creatinine level >1.5 mg/dL or 24 hour creatinine clearance <40 ml/min

     Absence of shock, bacterial infection, hypovolemia, or recent use of nephrotoxic


     No sustained improvement in renal function after fluid challenge with 1.5L NS

     Proteinuria<500mg/day and no renal parenchymal abnormalities on renal


Minor Criteria

     Urine volume< 500mL/day

     Urine sodium<10mEq/L

     Urine osmolality > plasma osmolality

     <50 RBC/hpf on urine microscopy

     serum sodium < 130 mEq/L