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Understanding acute kidney injury in cirrhosis: Current perspective
Sayan Malakar1, Sumit Rungta2, Arghya Samanta3
1Department of Gastroenterology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India.
World Journal of Hepatology
|June 12, 2025
Summary
Acute kidney injury (AKI) in cirrhosis patients significantly increases mortality. Early prediction, detection, and treatment of AKI are crucial for improving outcomes in decompensated cirrhosis and acute-on-chronic liver failure (ACLF).
Area of Science:
- Nephrology
- Hepatology
- Internal Medicine
Background:
- Acute kidney injury (AKI) affects 30-40% of hospitalized cirrhosis patients, with higher incidence in severe alcoholic hepatitis, spontaneous bacterial peritonitis, and acute-on-chronic liver failure (ACLF).
- Kidney injury is a critical event in cirrhosis, strongly linked to increased mortality.
- Pathophysiological factors include systemic vasodilation, cardiac dysfunction, hypoperfusion, endotoxemia, and direct nephrotoxicity.
Purpose of the Study:
- To provide a comprehensive review of the evolving concepts in the pathophysiology, diagnosis, and management of AKI in cirrhosis patients.
- To highlight the importance of early AKI detection and intervention in this high-risk population.
Main Methods:
- This review synthesizes current literature on the mechanisms and clinical aspects of AKI in cirrhosis.
- Focuses on the interplay between liver dysfunction, portal hypertension, systemic inflammation, and renal hemodynamics.
Main Results:
- Cirrhosis-associated AKI is driven by complex factors including altered gut permeability, bacterial translocation, inflammatory cascades, and activation of the renin-angiotensin-aldosterone system.
- Systemic vasodilation and reduced effective blood volume contribute to renal vasoconstriction and AKI development.
- Infections and pro-inflammatory cytokines play a direct role in kidney parenchymal injury.
Conclusions:
- Early prediction, detection, and prompt treatment of AKI are paramount in patients with decompensated cirrhosis and ACLF due to the associated high mortality.
- Understanding the intricate pathophysiology is key to developing effective management strategies for AKI in cirrhosis.
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