Do you still consider hepatorenal syndrome in patients with renal impairment and liver disease who are found to have rare muddy brown casts on urine microscopy?  

I personally do. While the traditional teaching is to try to differentiate ATN versus pre-renal versus HRS using the urine sodium, history, and urine microscopy. While sometimes one diagnosis is compelling, often the clinical picture is not clear cut, and at times there is a component of ATN on some...