Acute Kidney Injury in Acute on Chronic Liver Failure Versus Decompensated Cirrhosis—What Is the Difference?

Hepatorenal syndrome (HRS), the severe manifestation of renal injury in patients with cirrhosis and acute on chronic liver failure (ACLF), is characterized by decreased renal blood flow and glomerular filtration rate. Manuscript will elaborate how acute kidney injury (AKI) is different in ACLF and cirrhosis. We have role of biomarkers in differentiating HRS AKI from chronic kidney disease (CKD) in cirrhosis as well as ACLF patients. Medical therapy, timing of extracorporeal therapies, and role of liver transplant in patients of cirrhosis and ACLF. ACLF patients usually have structural form of AKI as compared to functional-volume responsive AKI in patients with cirrhosis. Combination of terlipressin and albumin augments renal recovery faster than other vasopressor therapies. But, liver transplant always remain the definitive treatment of progressive renal failure in patients with cirrhosis as well as ACLF.