Opinion Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2019; 25(28): 3684-3703
Published online Jul 28, 2019. doi: 10.3748/wjg.v25.i28.3684
Acute kidney injury spectrum in patients with chronic liver disease: Where do we stand?
Wiwat Chancharoenthana, Asada Leelahavanichkul
Wiwat Chancharoenthana, Immunology Unit, Department of Microbiology, Faculty of Medicine Chulalongkorn University, Bangkok 10330, Thailand
Asada Leelahavanichkul, Translational Research in Inflammation and Immunology Research Unit (TRIRU), Department of Microbiology, Faculty of Medicine Chulalongkorn University, Bangkok 10330, Thailand
Author contributions: Chancharoenthana W and Leelahavanichkul A searched and reviewed published articles and wrote the manuscript; Chancharoenthana W critically reviewed the article and made revisions to the manuscript; and both authors approved the final version of the article to be published.
Conflict-of-interest statement: All authors have no stated conflicts of interest related to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Asada Leelahavanichkul, MD, PhD, Assistant Professor, Lecturer, Translational Research in Inflammation and Immunology Research Unit (TRIRU), Department of Microbiology, Faculty of Medicine Chulalongkorn University, 1873 Rama IV Road, Bangkok 10330, Thailand. asada.l@chula.ac.th
Telephone: +66-2-2564132 Fax: +66-2-2525952
Received: February 27, 2019
Peer-review started: February 27, 2019
First decision: April 30, 2019
Revised: June 13, 2019
Accepted: July 1, 2019
Article in press: July 3, 2019
Published online: July 28, 2019

Acute kidney injury (AKI) is a common complication of liver cirrhosis and is of the utmost clinical and prognostic relevance. Patients with cirrhosis, especially decompensated cirrhosis, are more prone to develop AKI than those without cirrhosis. The hepatorenal syndrome type of AKI (HRS–AKI), a spectrum of disorders in prerenal chronic liver disease, and acute tubular necrosis (ATN) are the two most common causes of AKI in patients with chronic liver disease and cirrhosis. Differentiating these conditions is essential due to the differences in treatment. Prerenal AKI, a more benign disorder, responds well to plasma volume expansion, while ATN requires more specific renal support and is associated with substantial mortality. HRS–AKI is a facet of these two conditions, which are characterized by a dysregulation of the immune response. Recently, there has been progress in better defining this clinical entity, and studies have begun to address optimal care. The present review synopsizes the current diagnostic criteria, pathophysiology, and treatment modalities of HRS–AKI and as well as AKI in other chronic liver diseases (non-HRS–AKI) so that early recognition of HRS–AKI and the appropriate management can be established.

Keywords: Acute kidney injury, Acute-on-chronic liver failure, Chronic liver disease, Hepatorenal syndrome, Plasma perfusion and bilirubin adsorption and double plasma molecular absorption system, Fractionated plasma separation and adsorption, Molecular adsorbent recycling system, Single-pass albumin dialysis

Core tip: Acute kidney injury following advanced liver disease is a very common syndrome in clinical practice. Recent evidence from both basic research on pathophysiology and clinical studies has revealed a complex association between the liver and kidney through the vascular microenvironment and related immune mediators. These connections may play roles in promising new treatments of acute kidney injury on top of chronic liver disease. Furthermore, non-cell-based liver support systems have yielded promising preliminary data on the attenuation of the mortality rate of these conditions of dual organ failure.