World J Gastroenterol. Jul 14, 2021; 27(26): 3984-4003 Published online Jul 14, 2021. doi: 10.3748/wjg.v27.i26.3984
Acute kidney injury and hepatorenal syndrome in cirrhosis
Kapil Gupta, Abhishek Bhurwal, Cindy Law, Scott Ventre, Carlos D Minacapelli, Savan Kabaria, You Li, Christopher Tait, Carolyn Catalano, Vinod K Rustgi
Kapil Gupta, Abhishek Bhurwal, Cindy Law, Carlos D Minacapelli, You Li, Christopher Tait, Carolyn Catalano, Vinod K Rustgi, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
Scott Ventre, Savan Kabaria, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
Author contributions: All authors contributed to the research, writing, and editing of the submitted document.
Conflict-of-interest statement: There are no relevant financial disclosures or conflicts of interest for all authors.
Corresponding author: Vinod K Rustgi, MD, Professor, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place Medical Education Building, Rm # 479, New Brunswick, NJ 08901, United States. vr262@rwjms.rutgers.edu
Received: January 27, 2021 Peer-review started: January 27, 2021 First decision: March 7, 2021 Revised: March 19, 2021 Accepted: June 22, 2021 Article in press: June 22, 2021 Published online: July 14, 2021 Processing time: 165 Days and 5.4 Hours
Abstract
Acute kidney injury (AKI) in cirrhosis, including hepatorenal syndrome (HRS), is a common and serious complication in cirrhotic patients, leading to significant morbidity and mortality. AKI is separated into two categories, non-HRS AKI and HRS-AKI. The most recent definition and diagnostic criteria of AKI in cirrhosis and HRS have helped diagnose and prognosticate the disease. The pathophysiology behind non-HRS-AKI and HRS is more complicated than once theorized and involves more processes than just splanchnic vasodilation. The common biomarkers clinicians use to assess kidney injury have significant limitations in cirrhosis patients; novel biomarkers being studied have shown promise but require further studies in clinical settings and animal models. The overall management of non-HRS AKI and HRS-AKI requires a systematic approach. Although pharmacological treatments have shown mortality benefit, the ideal HRS treatment option is liver transplantation with or without simultaneous kidney transplantation. Further research is required to optimize pharmacologic and nonpharmacologic approaches to treatment. This article reviews the current guidelines and recommendations of AKI in cirrhosis.
Core Tip: This review paper is a comprehensive review of acute kidney injury in cirrhosis as well as hepatorenal syndrome. We review the most current topics including diagnosis, current definitions, pathophysiology, novel biomarkers, treatment, pharmacology, nonpharmacologic treatment, and topics of further research.
