AKI in ACLF: navigating the complex therapeutic puzzle.
1Department of Hepatology, Institute of Liver & Biliary Sciences, New Delhi, India.
Expert Review of Gastroenterology & Hepatology
|January 18, 2025
Summary
Acute kidney injury (AKI) in acute-on-chronic liver failure (ACLF) stems from inflammation and circulatory issues. Management requires tailored protocols, biomarker risk assessment, and exploring bile acid-targeting therapies.
Area of Science:
- Nephrology
- Hepatology
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) in acute-on-chronic liver failure (ACLF) is a critical complication.
- Pathophysiology involves systemic inflammation, portal hypertension, hyperbilirubinemia, and bile acid toxicity.
- AKI progression is rapid, often necessitating renal replacement therapy.
Purpose of the Study:
- To review the pathophysiological basis of AKI in ACLF.
- To discuss current therapeutic modalities and challenges in managing AKI in ACLF patients.
- To highlight the importance of customized protocols and novel therapies.
Main Methods:
- Comprehensive literature search of PubMed, Web of Science, and Scopus.
- Keywords included lactate, NGAL, PHTN, CRRT, PLEX, ACLF, and AKI.
- Included peer-reviewed English papers addressing AKI in ACLF.
Main Results:
- AKI in ACLF is primarily structural with reduced vasoconstrictor response.
- Management challenges include assessing severity and implementing effective treatments.
- Extracorporeal therapies targeting bile acids show potential.
Conclusions:
- AKI in ACLF necessitates customized management strategies.
- Biomarker-guided risk assessment is crucial for early intervention.
- Further research into extracorporeal therapies for AKI in ACLF is warranted.
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