Acute Kidney Injury in Patients With Cirrhosis and Hepatorenal Syndrome
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Acute kidney injury (AKI) in decompensated cirrhosis is a common complication. Revised consensus recommendations define AKI as an increase in serum creatinine ≥0.3 mg/dL within 48 hours or a percentage increase of serum creatinine ≥50% from a known or presumed baseline within the prior 7 days. Hepatorenal syndrome (HRS) results from severe peripheral vasodilatation, which leads to renal vasoconstriction. The definition of HRS-AKI (type I HRS) is provided in Table 19-5. Common precipitating factors include systemic bacterial infections, SBP, GI hemorrhage, and large-volume paracentesis without volume expansion. HRS is a diagnosis of exclusion.1
Adapted from Angeli P, Gines P, Wong F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. J Hepatol. 2015;62:968-974. [PMID:25638527]
AKI, acute kidney injury; HRS, hepatorenal syndrome; RBC, red blood cell.