The Kidney in Pediatric Liver Disease
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Published on: April 4, 2025
Robyn Greenfield Matloff1, Ronen Arnon
1Division of Pediatric Nephrology, Maria Fareri Children's Hospital of Westchester Medical Center, New York Medical College, Skyline Office # 1N-C12, 40 Sunshine Cottage Road, Valhalla, NY, 10595, USA, robyn_matloff@cwpw.org.
Insights
Pediatric liver disease impacts kidney function, causing complications like ascites and acute kidney injury. Liver transplantation can lead to chronic kidney disease and hypertension in children.
Area of Science:
- Pediatric Nephrology
- Hepatology
- Clinical Medicine
Background:
- The liver and kidney share a complex physiological relationship.
- Pediatric liver diseases significantly impact renal function and hemodynamics.
- Cirrhosis progression affects renal blood flow and electrolyte balance.
Purpose of the Study:
- To review the intricate relationship between pediatric liver disease and kidney function.
- To elucidate the mechanisms linking liver disorders to renal complications.
- To guide optimal care for children with liver disease and renal involvement.
Main Methods:
- Literature review of studies on pediatric liver disease and renal outcomes.
- Analysis of hemodynamic changes in pediatric cirrhosis.
- Examination of renal handling of sodium and water in liver disease.
Main Results:
- Progressive cirrhosis alters renal blood flow and sodium/water excretion.
- Ascites, hyponatremia, and acute kidney injury are common in advanced pediatric liver disease.
- Liver transplantation is associated with post-transplant chronic kidney disease and hypertension in children.
Conclusions:
- Understanding the liver-kidney axis is crucial for managing pediatric liver disease.
- Renal complications significantly contribute to morbidity and mortality in these patients.
- Improved management strategies are needed to address renal dysfunction post-liver transplantation.
Abstract:
There is an intricate relationship between the liver and the kidney, with renal physiology and function intimately involved in many primary disorders of pediatric liver disease. The hemodynamic changes of progressive cirrhosis affect and are directly affected by changes in renal blood flow and renal handling of sodium and free water excretion. Resulting complications of worsening ascites, hyponatremia, and acute kidney injury frequently complicate the care of children with advanced liver disease and contribute significant morbidity and mortality. While liver transplantation may restore hemodynamic stability, nearly 40% of pediatric liver transplant recipients develop chronic kidney disease post-transplant and approximately 25% are left with clinical hypertension. This review seeks to provide a basic understanding of this relationship to enable the provision of optimal care to children with liver disease.
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