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Acute kidney injury in children with chronic liver disease

Akash Deep1, Romit Saxena2, Bipin Jose2

  • 1Paediatric Intensive Care Unit (PICU), King's College Hospital, Denmark Hill, London, SE5 9RS, UK. akash.deep@nhs.net.

Pediatric Nephrology (Berlin, Germany)
|March 3, 2018
PubMed

Insights

Acute kidney injury (AKI) in children with liver disease is complex. This review focuses on hepatorenal syndrome (HRS) in pediatric chronic liver disease, highlighting diagnostic and treatment challenges.

Area of Science:

  • Pediatric Nephrology
  • Hepatology
  • Critical Care Medicine

Background:

  • Acute kidney injury (AKI) frequently complicates liver disease, with varied causes like pre-renal factors, acute tubular necrosis, and hepatorenal syndrome (HRS).
  • Pediatric-specific definitions and management guidelines for AKI in liver failure remain underdeveloped.
  • Understanding the pathophysiology of renal involvement in pediatric liver disease is crucial for effective treatment.

Purpose of the Study:

  • To explore the pathophysiological basis, treatment modalities, and controversies in diagnosing and treating AKI in pediatric patients with chronic liver disease.
  • To focus specifically on hepatorenal syndrome (HRS) as a distinct cause of kidney injury in this population.
  • To discuss current practices and identify gaps in pediatric-tailored approaches.

Main Methods:

  • Review of existing literature on AKI in pediatric liver disease.
  • Analysis of pathophysiological mechanisms linking liver dysfunction to kidney injury.
  • Discussion of diagnostic criteria and therapeutic interventions for HRS in children.

Main Results:

  • AKI in pediatric liver disease presents unique challenges compared to adults.
  • Hepatorenal syndrome (HRS) has specific diagnostic criteria and treatment strategies that differ from other AKI causes.
  • A lack of pediatric-specific data and literature hinders tailored management approaches.

Conclusions:

  • Pediatric AKI in chronic liver disease requires specialized attention, particularly concerning HRS.
  • Current treatment strategies for adults, including fluid resuscitation and vasoconstrictors, need adaptation for pediatric populations.
  • Further research and dedicated pediatric guidelines are essential for improving outcomes in children with liver disease and AKI.

Keywords:
Acute kidney injuryBiomarkersCirrhosisHepatorenal syndromeLiver failure

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