title: Acute kidney injury as a causal factor in mortality associated with hepatorenal syndrome.
abstract: OBJECTIVE
  We examine how acute kidney injury (AKI) contributes to mortality in patients with liver failure.
  
  
  BACKGROUND
  Hepatorenal syndrome (HRS) is a form of AKI in cirrhotic patients, which is defined as a purely physiologic derangement in renal function without any effect on renal parenchyma. Recent literature challenges this understanding. Little attention is paid to the presence of renal pathology and inflammatory alterations that occur as a result of HRS and their contribution to morbidity and mortality. In this paper, we propose that any type of AKI in the presence of liver disease is an inflammatory condition. The combination of AKI and liver failure produces a "toxic milieu" of cytokines, chemokines, and nitric oxide pathway metabolites that directly cause endothelial dysfunction affecting multiple organ systems. These global effects contribute to the increased short- and long-term mortality which has been established in the epidemiologic literature.
authors.affiliation: Renal Department, Montefiore Medical Centre, The University Hospital of Albert Einstein College of Medicine, Bronx, NY, USA, pdeshpan@montefiore.org.
authors.forename: Priya
authors.initials: P
authors.lastname: Deshpande
authors.forename: Katherine
authors.initials: K
authors.lastname: Rausa
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Turner
authors.forename: Mark
authors.initials: M
authors.lastname: Johnson
authors.forename: Ladan
authors.initials: L
authors.lastname: Golestaneh