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Kidneys in chronic liver diseases
World Journal of Gastroenterology
|July 14, 2012
Summary
Acute kidney injury (AKI) affects 20% of hospitalized patients with liver cirrhosis due to circulatory dysfunction. Early diagnosis and management, including liver transplantation referral, are crucial for improving outcomes in these vulnerable patients.
Area of Science:
- Nephrology
- Hepatology
- Internal Medicine
Background:
- Acute kidney injury (AKI) is prevalent in decompensated liver cirrhosis, affecting approximately 20% of hospitalized patients.
- Cirrhosis-associated AKI stems from impaired hemodynamics, including vasodilation, reduced effective blood volume, and activated vasoconstrictor systems.
Discussion:
- Common AKI causes in cirrhosis include pre-renal azotemia, hepatorenal syndrome (HRS), and acute tubular necrosis.
- Diagnosis involves clinical assessment, urine studies (natriuresis, osmolality), and response to interventions; renal biopsy is rarely needed.
- Chronic glomerulonephritis and obstructive uropathy are infrequent causes of azotemia in this population.
Key Insights:
- AKI signifies a late stage in chronic liver disease, underscoring the need for timely liver transplantation evaluation.
- Hepatorenal syndrome (HRS) is triggered by portal hypertension and factors like infections, inflammation, diuresis, hemorrhage, or nephrotoxins.
- Treatment varies by renal disease type, from volume expansion to renal replacement therapy.
Outlook:
- Type 1 HRS treatment involves vasoconstrictors and albumin, achieving ~50% efficacy.
- Second-line HRS therapies include transjugular intrahepatic portosystemic shunt (TIPS), renal vasoprotection, or artificial liver support.
- Optimizing AKI management in cirrhosis is vital for patient survival and transplant candidacy.
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