Nephrology and electrolytes: hepatorenal syndrome treatment: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Nephrology and electrolytes: hepatorenal syndrome treatment

Sample item

A man with decompensated alcohol-related cirrhosis and ascites has creatinine rising from 1.1 to 2.6 mg/dL. Diuretics were stopped and albumin was given for two days without improvement. There is no shock or nephrotoxin exposure, urine sodium is under 10 mmol/L and the urine sediment is bland. Which treatment is most appropriate?

AImmediate renal replacement as first-line therapyBLow-dose dopamine infusionCHigh-dose furosemide with saline infusionDIntravenous terlipressin with albumin

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Intravenous terlipressin with albumin

Failure to respond to diuretic withdrawal and albumin, with a bland sediment and low urine sodium, indicates functional renal failure from splanchnic vasodilatation and renal vasoconstriction. A vasoconstrictor such as terlipressin plus albumin improves renal perfusion. Liver transplantation is the definitive treatment, and dialysis is a bridge.

Option by option

A. Immediate renal replacement as first-line therapy
Dialysis is a bridge to transplant in selected patients, not the first-line therapy.
B. Low-dose dopamine infusion
Renal-dose dopamine has not been shown to benefit and is not recommended.
C. High-dose furosemide with saline infusion
Diuretics worsen intravascular depletion and are stopped in this condition.
D. Intravenous terlipressin with albumin (correct)
Correct. A splanchnic vasoconstrictor with albumin is the standard medical treatment.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Intravenous terlipressin with albumin. Failure to respond to diuretic withdrawal and albumin, with a bland sediment and low urine sodium, indicates functional renal failure from splanchnic vasodilatation and renal vasoconstriction.

Why is "Immediate renal replacement as first-line therapy" not the answer?

Dialysis is a bridge to transplant in selected patients, not the first-line therapy.

Why is "Low-dose dopamine infusion" not the answer?

Renal-dose dopamine has not been shown to benefit and is not recommended.

Why is "High-dose furosemide with saline infusion" not the answer?

Diuretics worsen intravascular depletion and are stopped in this condition.

What concept does this question test?

It tests Nephrology and electrolytes: hepatorenal syndrome treatment in General Medicine. A vasoconstrictor such as terlipressin plus albumin improves renal perfusion. Liver transplantation is the definitive treatment, and dialysis is a bridge.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Nephrology and electrolytes: hepatorenal syndrome treatment?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.