Hepatorenal Syndrome: A Severe, but Treatable, Cause of Kidney Failure in Cirrhosis  Cláudia Fagundes, MD, Pere Ginès, MD, PhD  American Journal of Kidney Diseases  Volume 59, Issue 6, Pages 874-885 (June 2012) DOI: 10.1053/j.ajkd.2011.12.032 Copyright © 2012 National Kidney Foundation, Inc. Terms and Conditions

Figure 1 Serum creatinine concentration and mean arterial pressure in the patient described in the case vignette. American Journal of Kidney Diseases 2012 59, 874-885DOI: (10.1053/j.ajkd.2011.12.032) Copyright © 2012 National Kidney Foundation, Inc. Terms and Conditions

Figure 2 Pathogenesis of circulatory abnormalities in (left) compensated cirrhosis and (right) hepatorenal syndrome. Reproduced from Ginès & Schrier15 with permission of the Massachusetts Medical Society. American Journal of Kidney Diseases 2012 59, 874-885DOI: (10.1053/j.ajkd.2011.12.032) Copyright © 2012 National Kidney Foundation, Inc. Terms and Conditions

Figure 3 Survival of patients with cirrhosis according to type of hepatorenal syndrome (HRS). Reproduced from Alessandria et al46 with permission of John Wiley & Sons. American Journal of Kidney Diseases 2012 59, 874-885DOI: (10.1053/j.ajkd.2011.12.032) Copyright © 2012 National Kidney Foundation, Inc. Terms and Conditions

Figure 4 Proposed treatment algorithm for patients with type 1 hepatorenal syndrome (HRS). Abbreviation: MELD, Model for End-Stage Liver Disease. aPotentially reversible chronic liver diseases (alcoholic hepatitis, acute-on-chronic liver failure, etc) with no important associated comorbid conditions. American Journal of Kidney Diseases 2012 59, 874-885DOI: (10.1053/j.ajkd.2011.12.032) Copyright © 2012 National Kidney Foundation, Inc. Terms and Conditions

Figure 5 Proposed treatment algorithm for patients with type 2 hepatorenal syndrome (HRS). Abbreviations: SCr, serum creatinine; Tx, transplant. aOnly in patients without adverse reactions to diuretics and with sodium excretion under diuretic treatment of >30 mEq/d. bEither terliprerssin if available or norepinephrine; therapy with a combination of midrodine and octreotide also could be an option. American Journal of Kidney Diseases 2012 59, 874-885DOI: (10.1053/j.ajkd.2011.12.032) Copyright © 2012 National Kidney Foundation, Inc. Terms and Conditions