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

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.

Renal safety after one year of sofosbuvir‐based therapy for chronic hepatitis C: A Brazilian “real‐life” study

“…Cirrhosis is directly associated with an increased risk for developing renal dysfunction, which adversely affects the survival of patients in advanced stages of liver disease . In addition, decompensated cirrhosis may aggravate pre‐existing glomerular injury in patients chronically infected with HCV .…”

“…Our results show that patients with kidney dysfunction did not experience significant changes in renal parameters after SOF- Cirrhosis is directly associated with an increased risk for developing renal dysfunction, which adversely affects the survival of patients in advanced stages of liver disease. 31,32 In addition, decompensated cirrhosis may aggravate pre-existing glomerular injury in patients chronically infected with HCV. 33 Our sample mostly con- which indicate that more studies evaluating CKD incidence after DAA treatment are needed.…”

Impact of Chronic Kidney Disease on Outcomes in Cirrhosis

“…However, caution is needed when interpreting such results because most studies have reported acute kidney injury (AKI) to be the most common form of renal impairment in hospitalized patients with cirrhosis with an estimated prevalence of 20%-50%. (2) Such a high prevalence of CKD among patients with cirrhosis is unexpected, even if functional CKD, previously known as type 2 hepatorenal syndrome (HRS), is taken into consideration. This may be because of a misclassification error leading to an overestimation of CKD prevalence.…”

Profile of Acute Kidney Injury in Patients with Decompensated Cirrhosis at a Tertiary-Care Center in Uttarakhand, India

“…This is commonly related to a reduction in urinary volume [1]. It is commonly found as a severe complication occurring in about 20-50% of the hospitalized cirrhotic patients [2][3][4]. It is often triggered by precipitating events such as overdose of diuretics, large-volume paracentesis without albumin replacement, gastrointestinal bleeding, and bacterial infections [5].…”

“…Large-volume paracentesis exceeding 5 L of ascitic fluid was performed for massive ascites under cover of an albumin infusion of 6-8 g/L of fluid removed [3,20]. In patients not having AKI, diuretics were given to prevent the reaccumulation of ascites.…”