Hépato-Gastro & Oncologie Digestive
MENUManagement of Acute Kidney Injury in cirrhosis Volume 26, issue 4, Avril 2019
- Key words: acute kidney injury, albumin, hepatorenal syndrome, terlipressin, liver transplantation
- DOI : 10.1684/hpg.2019.1763
- Page(s) : 395-401
- Published in: 2019
Management of acute kidney injury (AKI) in patients with cirrhosis has been simplified and is independent of its cause. This medical management relies on screening and treatment of triggering events (especially bacterial infection), withdrawal of all nephrotoxic drugs, and plasma volume expansion whenever required. The diagnosis of hepatorenal syndrome (HRS) is based on the absence of response after two consecutive days of plasma volume expansion with albumin. When HRS is diagnosed, patients should promptly receive vasoconstrictive drugs in association with albumin. Terlipressin is the most investigated vasoconstrictor, but noradrenaline may also be used in intensive care units whenever terlipressin is not available or poorly tolerated. Liver transplantation (LT) represents, theoretically, the definitive treatment of HRS. However, the non-recovery of renal function after LT is frequent and favored by unexpected advanced chronic kidney disease or by a prolonged AKI which may lead to a simultaneous liver-kidney transplantation. Prevention of AKI is crucial and includes plasma volume expansion when large volume paracentesis is required, antibioprophylaxis after a first episode of spontaneous bacterial peritonitis or in patients with acute gastrointestinal bleeding, and discontinuation of drugs susceptible to precipitate AKI.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License