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. 2017 May;5(2):127-137.
doi: 10.1093/gastro/gox009. Epub 2017 Apr 24.

Renal dysfunction in cirrhosis: acute kidney injury and the hepatorenal syndrome

Theresa Bucsics  1   2 , Elisabeth Krones  3
Affiliations

Renal dysfunction in cirrhosis: acute kidney injury and the hepatorenal syndrome

Theresa Bucsics et al. Gastroenterol Rep (Oxf). 2017 May.

Abstract

Renal dysfunction is a common complication of liver cirrhosis and of utmost clinical and prognostic relevance. Patients with cirrhosis are more prone to developing acute kidney injury (AKI) than the non-cirrhotic population. Pre-renal AKI, the hepatorenal syndrome type of AKI (HRS-AKI, formerly known as 'type 1') and acute tubular necrosis represent the most common causes of AKI in cirrhosis. Correct differentiation is imperative, as treatment differs substantially. While pre-renal AKI usually responds well to plasma volume expansion, HRS-AKI and ATN require different specific approaches and are associated with substantial mortality. Several paradigms, such as the threshold of 2.5 mg/dL for diagnosis of HRS-AKI, have recently been abolished and novel urinary biomarkers are being investigated in order to facilitate early and correct diagnosis and treatment of HRS-AKI and other forms of AKI in patients with cirrhosis. This review summarizes the current diagnostic criteria, as well as pathophysiologic and therapeutic concepts for AKI and HRS-AKI in cirrhosis.

Keywords: acute kidney injury; hepatorenal syndrome; liver cirrhosis.

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Figures

Figure 1.
Figure 1.
Pathophysiology of acute kidney injury (AKI) and hepatorenal syndrome (HRS) in decompensated cirrhosis. Broad arrows: vasodilation theory of ascites formation. Black arrows: ‘inflammation theory’ and further aspects of AKI development. Dashed line: impact of infections (i.e. spontaneous bacterial peritonitis) on portal hypertension. SNS, sympathetic nervous system; RAAS, renin-angiotensin-aldosterone system; SIRS, systemic inflammatory response syndrome; HRS-AKI, hepatorenal syndrome type of acute kidney injury
See this image and copyright information in PMC

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