Renal dysfunction in liver disease

Acute kidney injury is a frequently encountered complication in individuals with chronic liver disease. As in the general population, pre-renal, intrinsic and post-renal causes should be considered, with particular consideration given to sepsis and gastrointestinal bleeding. Hepatorenal syndrome (HRS) is a particular phenotype of acute kidney injury found in patients with decompensated cirrhosis and ascites, the diagnosis of which should be made only after excluding other causes. Acute and chronic renal dysfunction in cirrhosis is common, and both confer a negative impact on morbidity and mortality. As such, it is essential for all clinicians involved in the care of these individuals to be able to identify them in both inpatient and outpatient settings, so that appropriate management strategies can be promptly implemented. This article reviews the aetiology and management of renal dysfunction in individuals with chronic liver disease. HRS has a high morbidity and mortality, and its pathogenesis, diagnosis and specific management are highlighted here.