Treatment of Chronic Liver Failure in Liver Cirrhosis Complicated by Hepatorenal Syndrome – Acute Kidney Injury (HRS-AKI)

This protocol covers chronic liver failure in the specific setting of liver cirrhosis presenting with hepatorenal syndrome – acute kidney injury (HRS-AKI) at AKI stage greater than 1A, a clinically urgent complication that requires a defined, stepwise management approach.

Clinical scenario: Liver cirrhosis with confirmed hepatorenal syndrome – acute kidney injury (HRS-AKI), severity classified as AKI stage exceeding stage 1A.

Treatment approach: Evidence supports a transplantation-based strategy as the overarching management goal in this setting — the full protocol details the specific indications, clinical criteria, and decision points that determine the pathway.

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References

DOI: 10.1016/j.jhep.2018.03.024

LT is the best therapeutic option for patients with HRS regardless of the response to drug therapy (I;1).

The indication for liver-kidney transplantation remains controversial. This procedure should be considered in patients with significant CKD or with sustained AKI including HRS-AKI with no response to drug therapy (II-2;1).

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