Published online Jul 28, 2019. doi: 10.3748/wjg.v25.i28.3684
Peer-review started: February 27, 2019
First decision: April 30, 2019
Revised: June 13, 2019
Accepted: July 1, 2019
Article in press: July 3, 2019
Published online: July 28, 2019
Acute kidney injury (AKI) is a common complication of liver cirrhosis and is of the utmost clinical and prognostic relevance. Patients with cirrhosis, especially decompensated cirrhosis, are more prone to develop AKI than those without cirrhosis. The hepatorenal syndrome type of AKI (HRS–AKI), a spectrum of disorders in prerenal chronic liver disease, and acute tubular necrosis (ATN) are the two most common causes of AKI in patients with chronic liver disease and cirrhosis. Differentiating these conditions is essential due to the differences in treatment. Prerenal AKI, a more benign disorder, responds well to plasma volume expansion, while ATN requires more specific renal support and is associated with substantial mortality. HRS–AKI is a facet of these two conditions, which are characterized by a dysregulation of the immune response. Recently, there has been progress in better defining this clinical entity, and studies have begun to address optimal care. The present review synopsizes the current diagnostic criteria, pathophysiology, and treatment modalities of HRS–AKI and as well as AKI in other chronic liver diseases (non-HRS–AKI) so that early recognition of HRS–AKI and the appropriate management can be established.
Core tip: Acute kidney injury following advanced liver disease is a very common syndrome in clinical practice. Recent evidence from both basic research on pathophysiology and clinical studies has revealed a complex association between the liver and kidney through the vascular microenvironment and related immune mediators. These connections may play roles in promising new treatments of acute kidney injury on top of chronic liver disease. Furthermore, non-cell-based liver support systems have yielded promising preliminary data on the attenuation of the mortality rate of these conditions of dual organ failure.