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Acute Kidney Injury in Acute on Chronic Liver Failure Versus Decompensated Cirrhosis—What Is the Difference?

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Abstract

Purpose of Review

Hepatorenal syndrome (HRS), the severe manifestation of renal injury in patients with cirrhosis and acute on chronic liver failure (ACLF), is characterized by decreased renal blood flow and glomerular filtration rate. Manuscript will elaborate how acute kidney injury (AKI) is different in ACLF and cirrhosis.

Recent Findings

We have role of biomarkers in differentiating HRS AKI from chronic kidney disease (CKD) in cirrhosis as well as ACLF patients. Medical therapy, timing of extracorporeal therapies, and role of liver transplant in patients of cirrhosis and ACLF.

Summary

ACLF patients usually have structural form of AKI as compared to functional-volume responsive AKI in patients with cirrhosis. Combination of terlipressin and albumin augments renal recovery faster than other vasopressor therapies. But, liver transplant always remain the definitive treatment of progressive renal failure in patients with cirrhosis as well as ACLF.

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Data Availability

No datasets were generated or analyzed during the current study.

Abbreviations

HRS:

Hepatorenal syndrome

AKI:

Acute kidney injury

CKD:

Chronic kidney disease

AKD:

Acute kidney disease

GFR:

Glomerular filtration rate

RIFLE:

Risk, Injury, Failure, Loss, End-stage renal failure

AKIN:

Acute Kidney Injury Network

KDIGO:

Kidney Disease Improving Global Outcomes

MAP:

Mean arterial pressure

sCr:

Serum creatinine

ATN:

Acute Tubular necrosis

PAMP:

Pathogen-associated molecular patterns

DAMP:

Damage-associated molecular pattern

CTP:

Child Turcotte Pugh

MELD:

Model for end-stage liver disease

NGAL:

Neutrophil gelatinase-associated lipocalin

KIM:

Kidney injury molecule

OPN:

Osteopontin

TIMP:

Tissue inhibitors of metalloproteinases

MDRD:

Modification of diet in renal disease

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Authors and Affiliations

  1. Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India, 110070

    Satender Pal Singh, Tushar Madke & Rakhi Maiwall

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  1. Satender Pal Singh
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SPS formed the manuscript. TM helped in figures. RM critically revised the manuscript, provided input in tables and figures, commented on previous version of manuscript, and approved the final version.

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Correspondence to Rakhi Maiwall.

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Singh, S.P., Madke, T. & Maiwall, R. Acute Kidney Injury in Acute on Chronic Liver Failure Versus Decompensated Cirrhosis—What Is the Difference?. Curr Hepatology Rep 23, 294–305 (2024). https://doi.org/10.1007/s11901-024-00660-9

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