Hepatorenal Syndrome - 20/03/21

Doi : 10.1016/j.ccc.2020.11.011

Saro Khemichian, MD ^a, Claire Francoz, MD, PhD ^b, Francois Durand, MD ^c, Constantine J. Karvellas, MD, SM, FRCPC ^d, Mitra K. Nadim, MD ^e,^⁎
^a Division of Gastroenterology/Liver, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Los Angeles, CA 90033, USA
^b Hepatology and Liver Intensive Care, Hospital Beaujon, 100 Boulevard Du General Leclerc, Clichy 92110, France
^c Hepatology and Liver Intensive Care, Hospital Beaujon, University of Paris, 100 Boulevard Du General Leclerc, Clichy 92110, France
^d Division of Gastroenterology (Liver Unit), Department of Critical Care Medicine, University of Alberta, 1-40 Zeidler Ledcor Building, Edmonton, Alberta T6G 2X8, Canada
^e Division of Nephrology and Hypertension, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite 4300, Los Angeles, CA 90033, USA

^∗Corresponding author.

Résumé

Development of acute kidney injury in patients with chronic liver disease is common and portends a poor prognosis. Diagnosis remains challenging, as traditional markers, such as serum creatinine, are not reliable. Recent development of novel biomarkers may assist with this. Pathophysiology of this condition is multifactorial, relating to physiologic changes associated with portal hypertension, kidney factors, and systemic inflammatory response. Mainstay of treatment remains use of vasoconstrictors along with albumin. Recent guidelines streamline the selection of patients that will require simultaneous liver and kidney transplantation. Posttransplant kidney injury is common relating to multiple factors.

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Keywords : Acute on chronic liver failure, Acute kidney injury, Cirrhosis, Hepatorenal syndrome, Biomarkers, Liver transplantation, Simultaneous liver kidney transplantation, Model end-stage liver disease