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Acute kidney injury in acute liver failure: A narrative review

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Abstract

Acute kidney injury (AKI) is a frequent complication of acute liver failure (ALF) and it worsens the already worse prognoses of ALF. ALF is an uncommon disease, with varying etiologies and varying definitions in different parts of the world. There is limited literature on the impact of AKI on the outcome of ALF with or without transplantation. The multifaceted etiology of AKI in ALF encompasses factors such as hemodynamic instability, systemic inflammation, sepsis and direct nephrotoxicity. Indications of renal replacement therapy (RRT) for AKI in ALF patients extend beyond the conventional criteria for dialysis and continuous renal replacement therapy (CRRT) may have a role in transplant-free survival or bridge to liver transplantation (LT). LT is a life-saving option for ALF, so despite somewhat lower survival rates of LT in ALF patients with AKI, LT is not usually deferred. In this review, we will discuss the guidelines’ recommended definition and classification of AKI in ALF, the impact of AKI in ALF, the pathophysiology of AKI and the role of CRRT and LT in ALF patients with AKI.

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Authors and Affiliations

  1. Department of Gastroenterology, Indira Gandhi Medical College, Shimla, 171 001, India

    Brij Sharma, Anshul Bhateja, Rajesh Sharma, Ashish Chauhan & Vishal Bodh

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  1. Brij Sharma
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  2. Anshul Bhateja
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AB and VB wrote the initial manuscript; BS, RS, AC, and VB critically revised the manuscript. All authors reviewed and approved the final version.

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Correspondence to Vishal Bodh.

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Sharma, B., Bhateja, A., Sharma, R. et al. Acute kidney injury in acute liver failure: A narrative review. Indian J Gastroenterol (2024). https://doi.org/10.1007/s12664-024-01559-5

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