Abstract
Patients with cirrhosis have a high prevalence of renal dysfunction. The susceptibility
to renal dysfunction is due to both the severe splanchnic arterial vasodilation and
the systemic inflammation observed in these patients. An accurate assessment of renal
function is recommended in all patients with cirrhosis. Indeed, the renal function
assessment guides the management of patients, helps to refine prognosis and to define
transplant strategies. Despite its limitations, serum creatinine is still the most
used biomarker for the estimation of glomerular filtration rate (GFR) and the assessment
of acute kidney injury (AKI) in patients with cirrhosis. New biomarkers of GFR such
as cystatin C may improve the assessment of GFR and the prognostic stratification
in these patients. AKI is a life-threatening complication and needs a timely management.
The differential diagnosis between hepatorenal syndrome (HRS) and acute tubular necrosis
(ATN) is tricky in clinical practice. New biomarkers of kidney injury, such as neutrophil
gelatinase-associated lipocalin and interleukin-18, represent useful tools in refining
the discrimination between HRS and ATN. Patients with HRS need a prompt treatment
with vasoconstrictors and albumin and a rapid evaluation for liver transplant eligibility.
In this article, the authors reviewed the available tools in the diagnosis and management
of renal dysfunction in cirrhosis.
Keywords
hepatorenal syndrome - liver transplantation - terlipressin - renal failure - albumin
