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Digestive Disease Interventions 2022; 06(02): 131-136
DOI: 10.1055/s-0042-1746192
Review Article

Renal Dysfunction in Patients with Liver Cirrhosis

Mahmoud Sobh
1   Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
,
Mohamed Abdalbary
1   Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
2   Division of Nephrology and Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky
,
Mostafa Abdelsalam
1   Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
,
Amr El-Husseini Mohamed 
2   Division of Nephrology and Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky
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Abstract

Liver cirrhosis is a major health problem that can affect people of different ages. It induces pivotal hemodynamic and metabolic systemic disturbances along with other organs dysfunction. Renal dysfunction in cirrhotic patients is not uncommon, and subtle renal impairment is an early and very frequent finding. Liver cirrhosis can afflict kidney functions through different mechanisms. Renal vasoconstriction is usually the initial response of splanchnic vasodilation and decreased effective renal plasma flow. This induces a reduction of intraglomerular pressure leading to stimulation of renin-angiotensin system to maintain the glomerular filtration rate. Other causes of renal dysfunction include electrolytes and acid-base disturbances, systemic inflammation, bile cast nephropathy, and intra-abdominal hypertension. Loss of renal reserve is usually the earliest manifestation of kidney dysfunction in cirrhotic patients. This makes the kidney supersensitive to any subsequent hemodynamic or metabolic abnormalities. Proper assessment of kidney function is one of the major challenges in cirrhotic patients. The use of serum creatinine and creatinine-based equations is inaccurate and can overestimate kidney function. Hepato-renal syndrome (HRS) is a life-threatening disorder. In the last decade, there was significant progress in understanding the mechanism of this mysterious disorder. In this article, we are focusing on different mechanisms of kidney dysfunction in cirrhotic patients and the major diagnostic and therapeutic challenges.

Keywords

liver cirrhosis - kidney function - HRS


Publication History

Received: 03 December 2021

Accepted: 19 January 2022

Article published online:
13 June 2022

© 2022. Thieme. All rights reserved.

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