Abstract: Patients with cirrhosis are prone to developing acute kidney injury (AKI), which is defined by an acute increase in the serum creatinine of >0.3 mg/dL within 48 hours or by ≥50% from a stable baseline serum creatinine (sCr) within 3 months. Prerenal AKI, the hepatorenal syndrome (HRS), also known as HRS type 1, a particular form of prerenal AKI in liver cirrhosis, and acute tubular necrosis (ATN) represent the most common causes of renal dysfunction in cirrhotic patients. Teasing these two entities apart is of key importance because treatment differs substantially. While prerenal AKI usually responds well to plasma volume expansion, a diagnosis of HRS or ATN requires specific treatment approaches and is associated with substantial mortality. HRS is characterized mainly by functional renal failure due to renal vasoconstriction in the absence of underlying kidney pathology. The diagnosis of HRS is based on established diagnostic criteria aimed at excluding nonfunctional causes of renal failure. The prognosis of patients with HRS is poor, especially in those who have a rapidly progressive course. Liver transplantation is the best option in suitable candidates but difficult to implement in all patients because of the poor prognosis. Pharmacologic therapies based on the use of vasoconstrictor drugs plus intravenous albumin are the standard first line of therapy. Other treatments such as transjugular intrahepatic portosystemic shunts and renal replacement therapy may be effective, but experience is limited.
Publication Year: 2017
Publication Date: 2017-09-08
Language: en
Type: book-chapter
Indexed In: ['crossref']
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Cited By Count: 1
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