Acute Kidney Injury in Patients with Chronic Liver Disease: A Review

Area of Science:

• Nephrology
• Hepatology
• Internal Medicine

Background:

• Acute kidney injury (AKI) is a common and serious complication in patients with chronic liver disease (CLD).
• AKI significantly contributes to high morbidity and mortality rates globally in this patient population.
• Liver transplantation (LT) offers favorable outcomes, but effective early AKI management is critical for survival.

Purpose of the Study:

• To review the epidemiology, pathophysiology, management strategies, and prognosis of AKI in the context of CLD.
• To consolidate current knowledge on AKI in CLD to inform clinical practice and future research.

Main Methods:

• An extensive literature search was conducted using major scientific databases (PubMed, Medline, Google Scholar).
• The search focused on identifying studies detailing the epidemiology, burden, clinical presentations, prognosis, and management of AKI in CLD patients.

Main Results:

• AKI prevalence in hospitalized CLD patients varies widely.
• Multifactorial etiologies of AKI include prerenal causes, acute tubular injury, sepsis, GI bleeding, bacterial translocation, and hepatorenal syndrome (HRS).
• AKI increases morbidity, mortality, and risk of chronic kidney disease post-LT; management is etiology-dependent, with vasoconstrictors (e.g., terlipressin) showing promise for HRS-AKI, and LT as definitive treatment.

Conclusions:

• AKI is a critical complication of CLD requiring prompt recognition and intervention.
• Diagnosing and managing AKI, especially HRS, presents challenges and necessitates a high index of suspicion.
• Further research into novel therapeutic approaches is essential to enhance outcomes for AKI in CLD patients.