title: Renal dysfunction in cirrhosis is not just a vasomotor nephropathy.
abstract: The short-term mortality of cirrhotic patients who develop renal dysfunction remains unacceptably high, and as such the treatment of this condition is an unmet need. Although features of kidney injury are well recognized in these patients, the pathophysiology is complex and not completely understood. Improved understanding of the pathophysiological mechanisms involved in renal dysfunction occurring on a background of cirrhosis is key to developing effective treatment strategies to improve survival. Renal dysfunction due to hepatorenal syndrome (HRS) is characteristic of cirrhosis. Our current understanding is that HRS is functional in nature and occurs as a consequence of hemodynamic changes associated with portal hypertension. However, there is evidence in the literature suggesting that, histologically, the kidneys are not always normal in the vast majority of patients who present with renal dysfunction on the background of cirrhosis. Furthermore, there is emerging data implicating nonvasomotor mechanisms in the pathophysiology of renal dysfunction in cirrhosis. This mini-review aims to present the evidence suggesting that factors other than hemodynamic dysregulation have an important role in the development of this major complication for patients with progressive cirrhosis.
authors.affiliation: Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, UK.
authors.forename: Danielle
authors.initials: D
authors.lastname: Adebayo
authors.affiliation: Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, UK.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Morabito
authors.affiliation: UCL Centre for Nephrology, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Davenport
authors.affiliation: Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, UK.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Jalan
mesh_terms: D001647:Bile Acids and Salts / Q000097:blood; D001663:Bilirubin / Q000097:blood; D006801:Humans; D007239:Infections / Q000150:complications* / Q000503:physiopathology; D007249:Inflammation / Q000150:complications* / Q000503:physiopathology; D020381:Interleukin-17 / Q000378:metabolism; D059325:Intra-Abdominal Hypertension / Q000150:complications / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology; D051437:Renal Insufficiency / Q000209:etiology* / Q000503:physiopathology; D051197:Toll-Like Receptor 4 / Q000378:metabolism; D014666:Vasomotor System / Q000503:physiopathology
chemical_list: D001647:Bile Acids and Salts; D020381:Interleukin-17; C495345:TLR4 protein, human; D051197:Toll-Like Receptor 4; D001663:Bilirubin