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Acute Kidney Injury in Liver Disease

  • Akash Deep
  • Romit Saxena
Chapter

Abstract

Recent literature on acute kidney injury (AKI) has very clearly demonstrated an increasing risk of morbidity and mortality with increasing severity of AKI in critically ill children. However, AKI in the setting of liver disease has not been extensively studied. The peculiarities of liver disease, especially the fact that the usual criteria of diagnosing AKI in patients with non-liver disease (urine output and serum creatinine) cannot be accurately assessed in patients with liver disease, impedes diagnosis and follow up of kidney injury. Incidence, aetiology, pathogenesis and management of AKI will depend on the liver disease in question—acute liver failure, decompensated liver disease, acute-on-chronic liver failure or post liver transplantation. Though hepatorenal syndrome (HRS) is thought to be the most common entity in any kidney affection which takes place in patients with liver disease, it in fact is the least common amongst all causes of AKI in this patient population. Common causes include prerenal aetiology, acute tubular necrosis, drug-induced AKI and HRS. Therefore, AKI in liver disease can be a challenging entity for the treating clinician, right from diagnosing its aetiology to the management.

In this chapter, we explore the existing pathophysiological basis, treatment modalities and controversies in the diagnosis and treatment of AKI in paediatric patients with liver disease and discuss our own personal practice in this condition.

Keywords

Acute kidney injury Liver failure Cirrhosis Hepatorenal syndrome 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Paediatric Intensive Care UnitKing’s College HospitalLondonUK
  2. 2.Renal/CRRT Section of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC)GenevaSwitzerland
  3. 3.Paediatric Intensive Care UnitGreat Ormond Street HospitalLondonUK

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