Renal dysfunction is prevalent in patients with advanced
cirrhosis and decompensation. The presence of type 1
hepatorenal syndrome (HRS) has traditionally been defined by a set of stringent criteria based on serum
creatinine levels. These diagnostic criteria have been found to be too stringent to be widely applicable to patients with
cirrhosis, leading to underdiagnosis of
renal failure in this population.
Acute kidney injury (AKI) has now been proposed to characterize renal dysfunction in patients with
cirrhosis and is defined as an increase in serum
creatinine by 0.3 mg/dl in <48 h or an increase in serum
creatinine by 50% from a stable baseline reading within 3 months. Type 1 HRS is renamed HRS-AKI. Stage 1 AKI is defined by 0.3 mg/dl serum
creatinine or a 50% increase, stages 2 and 3 AKI are defined by a two-fold and three-fold increase in serum
creatinine levels, respectively. Data collected so far suggests that even stage 1 AKI is associated with worse prognosis in patients with
cirrhosis. The progression of AKI usually indicates substantially worse outcomes. A panel of
biomarkers, including inflammatory markers, are envisaged to
complement and enhance our current diagnostic criteria in the future and provide aetiology of the AKI.