The following is a summary of “Kidney Dysfunction in the Setting of Liver Failure: Core Curriculum 2024,” published in the December 2023 issue of Nephrology by Kanduri et al.
Patients with liver disease often encounter kidney dysfunction due to complex pathophysiological alterations. Advanced cirrhosis and acute liver failure (ALF) elevate the risk of acute kidney injury (AKI). One distinctive AKI subtype in cirrhosis and portal hypertension, termed Hepatorenal syndrome type 1 (HRS-1 or HRS-AKI), is marked by pronounced renal vasoconstriction and reduced kidney blood flow. However, HRS-1 can also involve acute tubular injury and renal vein congestion, complicating its clinical course. In ALF, AKI may arise from diverse factors like systemic inflammation, direct drug toxicity, or bile acid-induced tubulopathy.
Furthermore, the prevalence of nonalcoholic steatohepatitis is influencing the landscape of chronic kidney disease in cirrhosis. This AJKD Core Curriculum installment delves into the mechanisms behind how cirrhosis, ALF, acute cholestasis, and post-liver transplantation relate to various acute, subacute, or chronic kidney conditions. It covers recommended therapeutic approaches, encompassing supportive care, pharmacological treatments, kidney replacement therapy, and organ transplantation tailored to each condition. Moreover, this review outlines the significant acid-base and electrolyte imbalances commonly associated with hepatobiliary diseases.
Source: sciencedirect.com/science/article/abs/pii/S0272638623008442
