Latest Treatment of Acute Kidney Injury in Cirrhosis
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Liver (J Bajaj, Section Editor)
Latest Treatment of Acute Kidney Injury in Cirrhosis Florence Wong, MD, FRACP, FRCPC Address Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto General Hospital, 9th floor Eaton Wing, Room 222, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada Email: [email protected]
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Liver Keywords Acute-on-chronic liver failure I Albumin I Hemodynamics I Hepatorenal syndrome I Inflammation I Vasoconstrictors
Abstract Purpose of review To discuss the latest on the definition of acute kidney injury (AKI), its pathophysiology and treatment of the condition. Recent findings AKI in cirrhosis includes both functional and structural causes. Type 1 hepatorenal syndrome is a special form of functional AKI (HRS-AKI) associated with a very poor prognosis. The pathophysiology of AKI involves hemodynamic changes as well as inflammation. The treatment for AKI is mostly designed for HRS-AKI using albumin and vasoconstrictors to improve systemic hemodynamics, hence renal perfusion and function, resulting in a response rate of up to 44%. Otherwise, patients will need liver transplant as a definitive treatment, with combined liver kidney transplant reserved for patients with a prolonged history of AKI, underlying chronic kidney disease or hereditary renal conditions. Summary Early treatment of HRS-AKI improves chance of response. Future development of biomarkers may help to identify patients for early treatment.
Acute kidney injury (AKI) is a clinical syndrome whereby there is sudden deterioration in renal function, usually occurring in a patient with some underlying condition that predisposes to the development of AKI. The concept of AKI has undergone significant changes in recent years, especially when it is applied to patients with cirrhosis [1,2••]. It is a syndrome that encompasses both functional changes, as well as structural injuries in the kidneys [3]; its pathophysiology now involves several mechanisms [4•]; its classification is becoming increasingly complex [5]; and there are now increasing number of tools that can aid in its diagnosis [6,7]. With new knowledge of AKI in cirrhosis
Liver (J Bajaj, Section Editor) evolving over the past few years, it has become necessary to review treatment options for these patients, especially when new treatment algorithms are being developed. This review will discuss the new classification and diagnostic criteria of AKI in cirrhosis, the latest in our understanding of AKI pathophysiology, what diagnostic tools and treatments are available for these patients.
Definition and classification of AKI in cirrhosis For a long time, the presence of renal dysfunction in cirrhosis was synonymous with the occurrence of type 1 hepatorenal syndrome (HRS) [8], which is a severe form of renal failure that develops acutely in patients with advanced cirrhosis. However, its diagnosis requires a doubling of the serum
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