Acute Kidney Injury and Hepatorenal Syndrome in patients with cirrhosis: diagnostic and therapeutical novelties

Abstract

Occurrence of acute kidney injury (AKI) in cirrhotic patients is associated with poor outcome. Among AKI, hepatorenal syndrome (HRS) is a particular entity which is observed only in severe cirrhotic patients disclosing high level of portal hypertension and hepatocellular insufficiency. Definitions for AKI, HRS-AKI and specific medical management have been recently updated. HRS corresponds to an AKI with a functional profile associated with a high shortterm mortality rate in the absence of response to medical treatment. This latter associates albumin perfusion and vasoactive treatment such as terlipressin. This treatment improves short-term prognosis of responders to medical therapy. In case of treatment failure, renal replacement therapy (RRT) can be proposed. Decision-making process leading either to propose RRT or not depends mainly on eligibility to do liver transplantation. In absence of such eligibility assessed by local expertise, decision to start RRT should be based on the prognosis assessed by the number of organ failures and other variables such as age and comorbidities. The aims of this article are to discuss the new definition of AKI and AKI-HRS, treatment strategy particularly in the HRS setting and in patients who are not responding to medical therapy leading to take decision or not to start RRT.