Treatment-Hepatorenal syndrome (HRS)

• if critically ill → vasopressor (eg, norepinephrine or vasopressin) + albumin (1 g/kg, max 100 g, bolus daily) to ↑ MAP 10 mmHg.

• If not critically ill → octreotide (100–200 mcg SC tid) + midodrine (max 15 mg PO tid) + 1 g/kg (max 100 g) albumin on day of presentation followed by 20–60 g albumin qd to ↑ MAP.

• Terlipressin + albumin ↑ 10 d survival (not yet approved in U.S. but now recommended by AASLD) (NEJM 2021;384:818).

• May need dialysis or TIPS as bridge to liver transplant.