Acute kidney injury and hepatorenal syndrome in cirrhosis

Kapil Gupta, Abhishek Bhurwal, Cindy Law, Scott Ventre, Carlos D. Minacapelli, Savan Kabaria, You Li, Christopher Tait, Carolyn Catalano, Vinod K. Rustgi

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations


Acute kidney injury (AKI) in cirrhosis, including hepatorenal syndrome (HRS), is a common and serious complication in cirrhotic patients, leading to significant morbidity and mortality. AKI is separated into two categories, non-HRS AKI and HRS-AKI. The most recent definition and diagnostic criteria of AKI in cirrhosis and HRS have helped diagnose and prognosticate the disease. The pathophysiology behind non-HRS-AKI and HRS is more complicated than once theorized and involves more processes than just splanchnic vasodilation. The common biomarkers clinicians use to assess kidney injury have significant limitations in cirrhosis patients; novel biomarkers being studied have shown promise but require further studies in clinical settings and animal models. The overall management of non-HRS AKI and HRS-AKI requires a systematic approach. Although pharmacological treatments have shown mortality benefit, the ideal HRS treatment option is liver transplantation with or without simultaneous kidney transplantation. Further research is required to optimize pharmacologic and nonpharmacologic approaches to treatment. This article reviews the current guidelines and recommendations of AKI in cirrhosis.

Original languageEnglish (US)
Pages (from-to)3984-4003
Number of pages20
JournalWorld Journal of Gastroenterology
Issue number26
StatePublished - Jul 14 2021
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Gastroenterology


  • Acute kidney injury
  • Biomarkers
  • Hepatorenal syndrome
  • Liver cirrhosis
  • Prognosis
  • Treatment


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