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Review
. 2023 Jul 13;13(14):2361.
doi: 10.3390/diagnostics13142361.

Acute Kidney Injury in Liver Cirrhosis

Rose Mary Attieh  1 , Hani M Wadei  1
Affiliations
Review

Acute Kidney Injury in Liver Cirrhosis

Rose Mary Attieh et al. Diagnostics (Basel). .

Abstract

Acute kidney injury (AKI) is common in cirrhotic patients affecting almost 20% of these patients. While multiple etiologies can lead to AKI, pre-renal azotemia seems to be the most common cause of AKI. Irrespective of the cause, AKI is associated with worse survival with the poorest outcomes observed in those with hepatorenal syndrome (HRS) and acute tubular necrosis (ATN). In recent years, new definitions, and classifications of AKI in cirrhosis have emerged. More knowledge has also become available regarding the benefits and drawbacks of albumin and terlipressin use in these patients. Diagnostic tools such as urinary biomarkers and point-of-care ultrasound (POCUS) became available and they will be used in the near future to differentiate between different causes of AKI and direct management of AKI in these patients. In this update, we will review these new classifications, treatment recommendations, and diagnostic tools for AKI in cirrhotic patients.

Keywords: hepatorenal syndrome.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Suggested algorithm for the initial management of AKI in patients with cirrhosis and ascites. Careful clinical examination and frequent assessment of intravascular volume status by measuring inferior vena cava (IVC) diameter and collapsibility using Point-of-Care Ultrasound (POCUS) or bedside echocardiogram are needed to avoid volume overload from overzealous albumin infusion.
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