Abstract
The liver and kidney are key organs of metabolic homeostasis in the body and display
complex interactions. Liver diseases often have direct and immediate effects on renal
physiology and function. Conversely, acute kidney injury (AKI) is a common problem
in patients with both acute and chronic liver diseases. AKI in patients with acute
liver failure is usually multifactorial and involves insults similar to those seen
in the general AKI population. Liver cirrhosis affects and is directly affected by
aberrations in systemic and renal hemodynamics, inflammatory response, renal handling
of sodium and free water excretion, and additional nonvasomotor mechanisms. Subsequent
problems, for example, worsening ascites, hyponatremia, and AKI, often complicate
management of patients with chronic progressive liver disease and add to their morbidity
and mortality. Thus, AKI must be carefully defined and diagnosed in patients with
liver disease. The kidney also plays a pivotal role in balancing acid–base disturbances
resulting from advanced liver disease, making AKI in the setting of end-stage liver
disease very difficult to manage clinically. While renal dysfunction in these patients
often resolves following orthotopic liver transplant, dialysis may be required as
a bridge to transplantation to mitigate the metabolic disarray found in these critically
ill patients.
Keywords
acute kidney injury - acute liver failure - chronic liver disease - hepatorenal syndrome
