Hot Paper - Hepatorenal syndrome in acute-on-chronic liver failure with acute kidney injury: more questions requiring discussion

Hepatorenal syndrome in acute-on-chronic liver failure with acute kidney injury: more questions requiring discussion

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Songtao Liu 刘松涛 ¹ ², Qinghua Meng 孟庆华 ², Yuan Xu 许媛 ³, Jianxin Zhou 周建新 ¹

¹ Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
中国北京首都医科大学附属北京天坛医院重症医学科
² Department of Severe Liver Disease, Beijing You’an Hospital, Capital Medical University, Beijing, P. R. China
中国北京首都医科大学附属北京佑安医院重症肝病科
³ Department of Critical Care Medicine, Beijing Tsinghua Chang Gung Hospital, Beijing, P. R. China
中国北京北京清华长庚医院重症医学科

https://doi.org/10.1093/gastro/goab040

https://academic.oup.com/gastro/advance-article/doi/10.1093/gastro/goab040/6375168

Gastroenterology Report, 25 September 2021

Abstract

In cirrhosis with ascites, hepatorenal syndrome (HRS) is a specific prerenal dysfunction unresponsive to fluid volume expansion. Acute-on-chronic liver failure (ACLF) comprises a group of clinical syndromes with multiple organ failure and early high mortality. There are differences in the characterization of ACLF between the Eastern and Western medical communities. Patients with ACLF and acute kidney injury (AKI) have more structural injuries, contributing to confusion in diagnosing HRS-AKI.

In this review, we discuss progress in the pathogenesis, diagnosis, and management of HRS-AKI, especially in patients with ACLF. Controversy regarding HRS-AKI in ACLF and acute liver failure, hepatic carcinoma, shock, sepsis, and chronic kidney disease is also discussed. Research on the treatment of HRS-AKI with ACLF needs to be more actively pursued to improve disease prognosis.

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