Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2021; 27(26): 3984-4003
Published online Jul 14, 2021. doi: 10.3748/wjg.v27.i26.3984
Acute kidney injury and hepatorenal syndrome in cirrhosis
Kapil Gupta, Abhishek Bhurwal, Cindy Law, Scott Ventre, Carlos D Minacapelli, Savan Kabaria, You Li, Christopher Tait, Carolyn Catalano, Vinod K Rustgi
Kapil Gupta, Abhishek Bhurwal, Cindy Law, Carlos D Minacapelli, You Li, Christopher Tait, Carolyn Catalano, Vinod K Rustgi, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
Scott Ventre, Savan Kabaria, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
Author contributions: All authors contributed to the research, writing, and editing of the submitted document.
Conflict-of-interest statement: There are no relevant financial disclosures or conflicts of interest for all authors.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Vinod K Rustgi, MD, Professor, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place Medical Education Building, Rm # 479, New Brunswick, NJ 08901, United States.
Received: January 27, 2021
Peer-review started: January 27, 2021
First decision: March 7, 2021
Revised: March 19, 2021
Accepted: June 22, 2021
Article in press: June 22, 2021
Published online: July 14, 2021

Acute kidney injury (AKI) in cirrhosis, including hepatorenal syndrome (HRS), is a common and serious complication in cirrhotic patients, leading to significant morbidity and mortality. AKI is separated into two categories, non-HRS AKI and HRS-AKI. The most recent definition and diagnostic criteria of AKI in cirrhosis and HRS have helped diagnose and prognosticate the disease. The pathophysiology behind non-HRS-AKI and HRS is more complicated than once theorized and involves more processes than just splanchnic vasodilation. The common biomarkers clinicians use to assess kidney injury have significant limitations in cirrhosis patients; novel biomarkers being studied have shown promise but require further studies in clinical settings and animal models. The overall management of non-HRS AKI and HRS-AKI requires a systematic approach. Although pharmacological treatments have shown mortality benefit, the ideal HRS treatment option is liver transplantation with or without simultaneous kidney transplantation. Further research is required to optimize pharmacologic and nonpharmacologic approaches to treatment. This article reviews the current guidelines and recommendations of AKI in cirrhosis.

Keywords: Acute kidney injury, Hepatorenal syndrome, Liver cirrhosis, Treatment, Biomarkers, Prognosis

Core Tip: This review paper is a comprehensive review of acute kidney injury in cirrhosis as well as hepatorenal syndrome. We review the most current topics including diagnosis, current definitions, pathophysiology, novel biomarkers, treatment, pharmacology, nonpharmacologic treatment, and topics of further research.