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Systematic Initial AKI Workup
- Start the AKI workup in cirrhosis with urinalysis and urine sodium/FENa to categorize injury patterns.
- Use a volume challenge if pre-renal is suspected and escalate if no response to test for hepatorenal physiology.
Low Urine Sodium Is Not Definitive
- A low urine sodium or low FENa in cirrhosis is common and nondiagnostic by itself.
- Interpret urine tests cautiously because bilirubin and concentrated urine can stain hyaline casts and mimic ATN.
Match Volume Strategy To Exam
- Tailor volume expansion decisions to the clinical exam: avoid blanket albumin in visibly volume‑overloaded patients.
- If exam suggests hypovolemia, trial 1 g/kg/day albumin (25 g IV q6h) for 48 hours to assess response.