How do you approach the diagnosis of hepatorenal syndrome in a patient with cirrhosis and AKI who has not responded to albumin resuscitation but has a recent nephrotoxic exposure that could explain the renal dysfunction?

What is your approach to diagnosing hepatorenal syndrome in a patient with cirrhosis and AKI who has not responded to albumin resuscitation but has a recent nephrotoxic exposure?

• I favor HRS if urinalysis is bland and urinary sodium is low, regardless of the nephrotoxic exposure
• I favor ATN if the temporal relationship between the nephrotoxic exposure and AKI onset is compelling, even without classic urinalysis findings
• I rely primarily on urinary biomarkers such as NGAL to differentiate HRS from ATN
• Other