Acute Kidney Injury in Patients with Cirrhosis

Mitra K. Nadim, M.D., and Guadalupe Garcia-Tsao

Acute kidney injury (AKI) is a common condition in patients with cirrhosis. It occurs in up to 50% of hospitalized patients with cirrhosis and in 58% of such patients in the intensive care unit (ICU).^1-5 AKI is associated with high morbidity and mortality and an increased incidence of chronic kidney disease (CKD) after liver transplantation.^1-3,5,6 Progression to advanced stages of AKI (Table 1) portends an even worse prognosis.^1,2,5

In general, the three main causes of AKI¹¹ are renal hypoperfusion (also referred to as prerenal AKI), which in most cases is due to hypovolemia; intrinsic, structural kidney injury; and postrenal injury due to urinary obstruction. A unique cause of AKI due to renal hypoperfusion in patients with cirrhosis is the hepatorenal syndrome (HRS), which is the result of renal vasoconstriction. Hypoperfusion from hypovolemia accounts for approximately half the cases of AKI in patients with cirrhosis, intrinsic causes (e.g., acute tubular necrosis) account for approximately 30% of cases, and HRS accounts for approximately 15 to 20%, with less than 1% of cases attributable to postrenal obstruction.³

LEGGI TUTTO https://www.nejm.org/doi/full/10.1056/NEJMra2215289#:~:text=DOI%3A%2010.1056/NEJMra2215289