Acute nierschade bij patiënten met cirrose: differentiaaldiagnose en praktische aanpak

Abstract

Acute kidney injury in patients with cirrhosis: differential diagnosis and practical management The co-occurrence of renal and liver disease is common in clinical practice. Most frequently, this involves renal disease due to advanced liver disease. Acute kidney insufficiency (AKI) as a complication of primary liver disease is associated with a high mortality and morbidity. The most common causes of AKI in patients with cirrhosis are hypovolemia, hepato-renal syndrome (HRS) and acute tubular necrosis, which account for more than 80% of AKI in this population. Determining the exact aetiology in the setting of cirrhosis can be difficult. Pre-renal AKI is treated with volume resuscitation, HRS with vasoconstrictors and intravenous albumin, and acute tubular necrosis with supportive therapy. Terlipressin combined with albumin infusion is the most effective treatment for HRS-AKI. New biomarkers for tubular kidney injury could help in the differential diagnosis between structural and/or functional causes of renal insufficiency. The place of simultaneous liver-kidney transplantation in the treatment of HRS-AKI is still under debate. AKI in patients with cirrhosis is a frequent complication with a high mortality rate. Early diagnosis of the exact cause of AKI is of utmost importance, as the treatment options depend on the cause of renal failure. This review article describes the aetiology and practical management of AKI in patients with cirrhosis.