title: Acute kidney injury and hepatorenal syndrome in cirrhosis.
abstract: Cirrhosis is the eighth leading cause of "years of lost life" in the United States and accounts for approximately 1% to 2% of all deaths in Europe. Patients with cirrhosis have a high risk of developing acute kidney injury. The clinical characteristics of hepatorenal syndrome (HRS) are similar to prerenal uremia, but the condition does not respond to volume expansion. HRS type 1 is rapidly progressive whereas HRS type 2 has a slower course often associated with refractory ascites. A number of factors can precipitate HRS such as infections, alcoholic hepatitis, and bleeding. The monitoring, prevention, early detection, and treatment of HRS are essential. This paper reviews the value of early evaluation of renal function based on two new sets of diagnostic criteria. Interventions for HRS type 1 include terlipressin combined with albumin. In HRS type 2, transjugular intrahepatic portosystemic shunt (TIPS) should be considered. For both types of HRS patients should be evaluated for liver transplantation.
authors.affiliation: Department of Gastroenterology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
authors.forename: Mads
authors.initials: M
authors.lastname: Egerod Israelsen
authors.forename: Lise Lotte
authors.initials: LL
authors.lastname: Gluud
authors.forename: Aleksander
authors.initials: A
authors.lastname: Krag
mesh_terms: D058186:Acute Kidney Injury / Q000145:classification / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D000418:Albumins / Q000008:administration & dosage; D001201:Ascites / Q000209:etiology; D018450:Disease Progression; D004359:Drug Therapy, Combination; D042241:Early Diagnosis; D006530:Hepatorenal Syndrome / Q000145:classification / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D016031:Liver Transplantation; D008236:Lypressin / Q000008:administration & dosage / Q000031:analogs & derivatives; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D000077585:Terlipressin
chemical_list: D000418:Albumins; D008236:Lypressin; D000077585:Terlipressin
keywords: acute kidney injury; acute-on-chronic liver failure; adrenal insufficiency; cirrhosis; cirrhotic cardiomyopathy; hepatorenal syndrome