Review
Copyright ©2007 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2007; 13(42): 5552-5559
Published online Nov 14, 2007. doi: 10.3748/wjg.v13.i42.5552
Acute renal dysfunction in liver diseases
Alex P Betrosian, Banwari Agarwal, Emmanuel E Douzinas
Alex P Betrosian, Emmanuel E Douzinas, Third Department of Critical Care, Athens University, Evgenidion Hospital, Papadiamantopoulou 20, Athens 11528, Greece
Banwari Agarwal, Intensive Therapy Unit, Royal Free Hospital, London, United Kingdom
Author contributions: All authors contributed equally to the work.
Correspondence to: Alex Betrosian, MD, Third Department of Critical Care, Athens University, Evgenidion Hospital, Papadiamantopoulou 20, Athens 11528, Greece. abetrosian@gmail.com
Telephone: +30-210-7208116
Received: June 24, 2007
Revised: August 19, 2007
Accepted: August 29, 2007
Published online: November 14, 2007
Abstract

Renal dysfunction is common in liver diseases, either as part of multiorgan involvement in acute illness or secondary to advanced liver disease. The presence of renal impairment in both groups is a poor prognostic indicator. Renal failure is often multifactorial and can present as pre-renal or intrinsic renal dysfunction. Obstructive or post renal dysfunction only rarely complicates liver disease. Hepatorenal syndrome (HRS) is a unique form of renal failure associated with advanced liver disease or cirrhosis, and is characterized by functional renal impairment without significant changes in renal histology. Irrespective of the type of renal failure, renal hypoperfusion is the central pathogenetic mechanism, due either to reduced perfusion pressure or increased renal vascular resistance. Volume expansion, avoidance of precipitating factors and treatment of underlying liver disease constitute the mainstay of therapy to prevent and reverse renal impairment. Splanchnic vasoconstrictor agents, such as terlipressin, along with volume expansion, and early placement of transjugular intrahepatic portosystemic shunt (TIPS) may be effective in improving renal function in HRS. Continuous renal replacement therapy (CRRT) and molecular absorbent recirculating system (MARS) in selected patients may be life saving while awaiting liver transplantation.

Keywords: Hepatorenal syndrome; Transjugular intrahepatic portosystemic shunt; Continuous renal replacement therapy; Molecular absorbent recirculating system; Acute liver failure; Systemic vascular resistance; Renal blood flow