title: Renal dysfunction in cirrhosis.
abstract: OBJECTIVE
  Renal dysfunction causes significant morbidity in cirrhotic patients. Diagnosis is challenging because it is based on serum creatinine, which is used to calculate estimated glomerular filtration rate, which itself is not an ideal measure of renal function in patients with cirrhosis. Finding the exact cause of renal injury in patients with cirrhosis remains problematic due to the limitations of the current diagnostic tests. The purpose of this review is to highlight studies used to diagnose renal dysfunction in patients with renal dysfunction and review current treatments.
  
  
  RESULTS
  New diagnostic criteria and classification of renal dysfunction, especially for acute kidney injury (AKI), have been proposed in hopes of optimizing treatment and improving outcomes. New biomarkers that help to differentiate structural from functional AKI in cirrhotic patients have been developed, but require further investigation. Vasoconstrictors are the most commonly recommended treatment of hepatorenal syndrome (HRS). Given the high mortality in patients with type 1 HRS, all patients with HRS should be evaluated for liver transplantation. When renal dysfunction is considered irreversible, combined liver-kidney transplantation is advised.
  
  
  CONCLUSIONS
  Development of new biomarkers to differentiate the different types of AKI in cirrhosis holds promise. Early intervention in cirrhotic patients with renal dysfunction offers the best hope of improving outcomes.
authors.affiliation: aDepartment of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland bDepartment of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Nathalie H
authors.initials: NH
authors.lastname: Urrunaga
authors.forename: Ayse L
authors.initials: AL
authors.lastname: Mindikoglu
authors.forename: Don C
authors.initials: DC
authors.lastname: Rockey
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000503:physiopathology* / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood*; D003937:Diagnosis, Differential; D006530:Hepatorenal Syndrome / Q000097:blood / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D016030:Kidney Transplantation; D008103:Liver Cirrhosis / Q000097:blood / Q000503:physiopathology* / Q000628:therapy; D016031:Liver Transplantation; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D015415:Biomarkers; D014662:Vasoconstrictor Agents; D003404:Creatinine