title: Renal interactions in liver dysfunction and failure.
abstract: OBJECTIVE
  This review will summarize the recent advances in our understanding of the relationship between liver and kidney function. It will outline the new concepts of the pathophysiology of renal dysfunction in chronic liver disease and examine novel renal biomarkers to detect acute kidney injury (AKI) in cirrhosis and following liver transplantation. We will further review new treatments for hepatorenal syndrome (HRS) and approaches to kidney dysfunction in liver transplantation recipients.
  
  
  RESULTS
  Recent studies evaluated the effect of the renin-angiotensin system on hepatic fibrosis and the role of the gut in mediating AKI after hepatic ischemia reperfusion injury. Multiple studies have investigated novel biomarkers such as neutrophil gelatinase-associated lipocalin to predict AKI (and HRS) in cirrhosis and after liver transplantation. Furthermore, there were recent advances in the management of kidney dysfunction including management of HRS with vasopressin analogs and kidney-sparing immunosuppression after liver transplantation.
  
  
  CONCLUSIONS
  Greater knowledge of the physiologic relationship between kidney and liver may open avenues for specific therapies of liver and kidney injury. Renal biomarkers may allow early diagnosis and targeted treatment of AKI, and improved management of kidney disease in the preliver and postliver transplantation setting will be crucial to improving long-term outcomes in these patients.
authors: Division of Digestive and Liver Diseases, Department of Medicine, Center for Liver Disease and Transplantation, Columbia University College of Physicians and Surgeons, New York, NY 10032-3784, USA.
authors: Elizabeth C
authors: EC
authors: Verna
authors: Gebhard
authors: G
authors: Wagener
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy / Q000276:immunology* / Q000503:physiopathology; D042241:Early Diagnosis; D005260:Female; D006530:Hepatorenal Syndrome / Q000188:drug therapy / Q000276:immunology* / Q000503:physiopathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D008107:Liver Diseases / Q000276:immunology* / Q000503:physiopathology / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects / Q000276:immunology*; D008297:Male; D012084:Renin-Angiotensin System; D014667:Vasopressins / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents; D014667:Vasopressins