Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Sep 28, 2015; 7(21): 2336-2343
Published online Sep 28, 2015. doi: 10.4254/wjh.v7.i21.2336
Renal failure in cirrhosis: Emerging concepts
Paulo Lisboa Bittencourt, Alberto Queiroz Farias, Carlos Terra
Paulo Lisboa Bittencourt, Unit of Gastroenterology and Hepatology, Portuguese Hospital, Salvador, BA 40140-901, Brazil
Alberto Queiroz Farias, University of São Paulo School of Medicine, São Paulo, SP 054003-000, Brazil
Carlos Terra, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro, RJ 20551-030, Brazil
Author contributions: Bittencourt PL, Farias AQ and Terra C contributed equally to this work, writing and reviewing the manuscript and generating the tables.
Conflict-of-interest statement: The authors declare no conflict of interest related to the manuscript.
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:
Correspondence to: Paulo Lisboa Bittencourt, MD, Unit of Gastroenterology and Hepatology, Portuguese Hospital, Clementino Fraga 220, Apto 1901, Ondina, Salvador, BA 40170-050, Brazil.
Telephone: +55-71-2033457 Fax: +55-71-2033456
Received: June 27, 2015
Peer-review started: June 29, 2015
First decision: August 5, 2015
Revised: August 29, 2015
Accepted: September 7, 2015
Article in press: September 8, 2015
Published online: September 28, 2015

Acute renal failure, now termed acute kidney injury (AKI), is frequently found in patients with cirrhosis. The occurrence of AKI, irrespective of the underlying cause, is associated with reduced in-hospital, 3-mo and 1-year survival. Hepatorenal syndrome is associated with the worst outcome among AKI patients with cirrhosis. Several definitions for AKI that have been proposed are outlined and evaluated in this paper. Among these, the International Club for Ascites-AKI criteria substantially strengthen the quality of early diagnosis and intervention according to underlying cause of AKI.

Keywords: Renal failure, End-stage liver disease, Acute kidney injury, Hepatorenal syndrome, Liver cirrhosis

Core tip: Acute kidney injury (AKI) is frequently observed in hospitalized patients with cirrhosis and is associated with increased mortality. Recently a new definition for AKI has been proposed by the International Club of Ascites in order to allow early diagnosis and management of AKI in cirrhosis with the purpose of reducing its mortality, particularly with the occurrence of hepatorenal syndrome.