KEY POINTS
(1) In cirrhosis, acute kidney injury (AKI) is mainly due to prerenal factors [including type 1 hepatorenal syndrome (HRS)] and ischemic acute tubular necrosis (ATN).
(2) IN cirrhosis, chronic kidney disease (CKD) may be due to type 2 HRS, immunoglobulin A (IgA) nephropathy, or membranoproliferative glomerulonephritis. Some patients have acute-on-chronic kidney injury.
(3) In patients with cirrhosis and CKD waiting for liver transplantation, renal biopsy may be indicated because histopathological analysis of renal biopsy specimens provides diagnostic and prognostic information. In these patients, the transjugular route can be safely used. (4) Treatments of AKI should target the cause of renal hypoperfusion (eg, fluid replacement to treat intravascular volume depletion or vasoconstrictor therapy for type 1 HRS). There is no specific treatment for ATN; renal replacement therapy may be used.
(5) Treatments of CKD depend on the cause. There is no established therapy for type 2 HRS or IgA nephropathy; patients with chronic hepatitis C and membranoproliferative glomerulonephritis may benefit from antiviral therapy. (6) Combined liver and kidney transplantation may be used in some patients with cirrhosis and CKD. The decision is based on the value of the glomerular filtration rate (ideally one should use the measured value and not the estimated value) and the results of renal biopsy.