Table 1.
Proposed Classification of Renal Dysfunction in Cirrhosis Based on Renal Plasma Flow and GFR
| No Baseline Acute or Chronic Kidney Disease* | RPF | GFR | Filtration Fraction | Renal Disease | ||||
| → | Normal | Normal | Normal/Baseline |
|
Stage 0 | |||
| → | Mild to Moderately Reduced from Baseline | Normal/Low Normal (Mildly Reduced from Baseline) | Increased from Baseline | → | Pre-HRS | Stage 1 | ||
| Hypovolemia | ||||||||
| Hypoperfusion other than HRS | ||||||||
| → | Moderate to Severely Reduced from Baseline | Moderate to Severely Reduced from Baseline | Normal, Increased or Reduced from Baseline | → | HRS Type II | Stage 2 | ||
| HRS Type I | ||||||||
| Hypovolemia | ||||||||
| Hypoperfusion other than HRS | ||||||||
| → | Prolonged or Severely Reduced from Baseline | Prolonged or Severely Reduced from Baseline | Normal, Increased or Reduced from Baseline | → | Ischemic Acute Tubular Necrosis (Complete or Partial Recovery) | Stage 3 | ||
| → | Prolonged or Severely Reduced from Baseline | Prolonged or Severely Reduced from Baseline | Normal, Increased or Reduced from Baseline | → | Ischemic Acute Tubular Necrosis (No Recovery) | Stage 4 | ||
| Baseline Chronic Kidney Disease | RPF | GFR | Filtration Fraction | Renal Disease | ||||
| → | Normal or Reduced (Baseline) | Reduced (Baseline) | Baseline |
|
Stage 0 | |||
| → | Mild to Moderately Reduced from Baseline | Reduced (Baseline) or Mildly Reduced from Baseline | Increased from Baseline | → | Pre-HRS | Stage 1 | ||
| Hypovolemia | ||||||||
| Hypoperfusion other than HRS | ||||||||
| → | Moderate to Severely Reduced from Baseline | Moderate to Severely Reduced from Baseline | Normal, Increased or Reduced from Baseline | → | HRS Type II | Stage 2 | ||
| HRS Type I | ||||||||
| Hypovolemia | ||||||||
| Hypoperfusion other than HRS | ||||||||
| → | Prolonged or Severely Reduced from Baseline | Prolonged or Severely Reduced from Baseline | Normal, Increased or Reduced from Baseline | → | Ischemic Acute Tubular Necrosis (Complete or Partial Recovery) | Stage 3 | ||
| → | Prolonged or Severely Reduced from Baseline | Prolonged or Severely Reduced from Baseline | Normal, Increased or Reduced from Baseline | → | Ischemic Acute Tubular Necrosis (No Recovery) | Stage 4 | ||
*
Spot urine protein to creatinine ratio should be checked to ascertain the absence of a glomerular disease.