Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. May 8, 2015; 7(7): 993-1000
Published online May 8, 2015. doi: 10.4254/wjh.v7.i7.993
Acute kidney injury in patients with chronic liver disease
Nicolas Rognant
Nicolas Rognant, Nephrology Department, Centre Hospitalier Lyon-Sud, F69495 Pierre Benite Cedex, France
Author contributions: Rognant N solely contributed to this paper.
Conflict-of-interest: None.
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: Nicolas Rognant, MD, PhD, Nephrology Department, Centre Hospitalier Lyon-Sud, 165 Chemin du Grand Revoyet, F69495 Pierre Benite Cedex, France.
Telephone: + 33-472-678709 Fax: + 33-472-678710
Received: August 29, 2014
Peer-review started: August 29, 2014
First decision: December 17, 2014
Revised: January 5, 2015
Accepted: February 9, 2015
Article in press: February 11, 2015
Published online: May 8, 2015

Acute kidney injury (AKI) is a frequent clinical event in patients with liver disease, compounding their prognosis. Furthermore, it is likely that the occurrence of AKI has a detrimental impact on the subsequent renal function and the long-term survival of these patients. Recently, some authors advocated the use of new diagnostic criteria for detecting acute kidney injury in patients with cirrhosis. These criteria are based on the rapidity and extent of the creatinine increase comparing to the basal creatinine and also on the kinetics of diuresis decrease. Although their validity in this population requires further studies to be clearly established, these new criteria could have two advantages: (1) to allow earlier diagnosis of AKI and, thus, hepatorenal syndrome for which earlier intervention could improve patients’ survival; and (2) to promote more intensive monitoring of renal function in these patients with high risk of AKI. Finally, recent practice guidelines about the prevention and treatment of general AKI have been published which should be useful in optimising the management of AKI in cirrhotic patients.

Keywords: Acute kidney injury, Cirrhosis, Hepatorenal syndrome, Serum creatinine, RIFLE/AKIN classification

Core tip: Acute kidney injury (AKI) is associated with detrimental effect on early survival in hospitalised cirrhotic patients. Due to several hemodynamic modifications, both at the systemic and renal level, induced by cirrhosis, these patients are at increased risk to present acute kidney injury. Recently, new diagnostic criteria have been developed to insure early detection and allow severity assessment of AKI and to optimize the patient’s treatment. The studies available so far, showed that these criteria could have a clinical interest in the management of renal dysfunction but additional data are needed to ascertain their clinical benefit.