Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis

Abstract

Acute kidney injury (AKI) is common in hospitalized patients with cirrhosis. Hepatorenal syndrome (HRS) is a type of AKI known as HRS-AKI. It is a severe complication of cirrhosis with high morbidity and mortality. While certain vasoconstrictor medications have been shown to improve HRS-AKI, no clear transplant-free survival benefit has been reported with medical therapies. Patients with HRS-AKI should be considered for urgent liver transplantation evaluation. In this review, we discuss the most recent updates on the definition, diagnosis, and management of AKI in cirrhosis, with special a emphasis on HRS.

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

Figure 1

Pathophysiology of hepatorenal syndrome. Abbreviations: CO: carbon monoxide, GFR: glomerular filtration rate, IL: interleukin, NO: nitric oxide, PAMPs: pathogen-associated molecular patterns, TNF: tumor necrosis factor.