Acute Kidney Injury and Hepatorenal Syndrome

  • Salvatore Piano
  • Paolo AngeliEmail author


Acute kidney injury (AKI) is a life-threatening complication in patients with liver cirrhosis. AKI is frequently triggered by a precipitating event such as a bacterial infection, the use of diuretics, and/or gastrointestinal bleeding. Each of these precipitating conditions leads to a reduction in the effective circulating volume due to splanchnic arterial vasodilation, which impairs renal perfusion. Hepatorenal syndrome (HRS-AKI) is a particular type of AKI characterized by severe arterial vasoconstriction in response to severe splanchnic arterial vasodilation that cannot be solved by plasma volume expansion. HRS-AKI is the most life-threatening type of AKI and should be diagnosed and treated promptly. The differential diagnosis between HRS-AKI and acute tubular necrosis may be difficult. Pharmacological treatment of HRS-AKI with vasoconstrictors and albumin has been shown to be effective, but liver transplantation represents the best treatment of this condition. This chapter reviews the current knowledge on the pathophysiology and management of AKI and HRS-AKI in patients with cirrhosis.


Acute renal failure Hepatorenal syndrome AKI Cirrhosis Liver transplantation Terlipressin albumin 


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Authors and Affiliations

  1. 1.Unit of Internal Medicine and Hepatology, Department of Medicine, University of PadovaPadovaItaly

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