Knowledge Portal
AKI and hepatorenal syndrome
Acute kidney injury in cirrhosis is common and often multifactorial. Hepatorenal syndrome–AKI is a clinical phenotype rather than a simple synonym for every rise in creatinine, and functional and structural kidney injury may coexist. The useful bedside approach is to look actively for reversible causes, interpret fluid and albumin responsiveness in context, select vasoconstrictor therapy carefully and link decisions about renal replacement therapy to prognosis and transplant candidacy.
Key information
Guidelines and position statements
Relevant clinical practice guidelines, practice guidance, consensus statements and position papers from professional bodies and expert groups.
Acute kidney injury in patients with cirrhosis
ADQI/ICA · joint multidisciplinary consensus · 2024
Current consensus criteria and recommendations for AKI and HRS-AKI diagnosis, volume assessment, treatment and follow-up.
Open resource →Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome
AASLD · practice guidance · 2021
AASLD guidance on ascites, albumin, HRS-AKI, vasoconstrictor therapy, SBP and transplantation.
Open resource →Further context
Other useful resources
Selected review articles, practical explainers, expert discussions, reference sites and e-learning from established providers.
Understanding acute kidney injury in cirrhosis: Current perspective
Malakar S, et al. World Journal of Hepatology. 2025;17(5):104724.
A recent open-access overview spanning pathophysiology, diagnosis, biomarkers and treatment.
Open resource →Update on Hepatorenal Syndrome: From Pathophysiology to Treatment
Khemichian S, Nadim MK, Terrault NA. Annual Review of Medicine. 2025;76:373–387.
A focused update on changing HRS concepts and the evidence behind contemporary treatment.
Open resource →From past to present to future: Terlipressin and hepatorenal syndrome–acute kidney injury
Allegretti AS, et al. Hepatology. 2024.
A balanced review of terlipressin efficacy, safety, patient selection and unresolved questions.
Open resource →Are we relearning how to manage renal dysfunction in cirrhosis?
EASL Studio · expert discussion
A discussion of revised AKI/HRS definitions and the practical implications of ATTIRE and CONFIRM.
Open resource →Why are patients with cirrhosis susceptible to hepatorenal syndrome?
AASLD Liver Fellow Network · clinical explainer
A useful pathophysiology-led explanation of HRS and the limits of a purely functional model.
Open resource →Hepatorenal syndrome
Deranged Physiology · ICU revision chapter · updated 2025
An exam-oriented critical-care summary; use alongside current consensus definitions.
Open resource →Hepatorenal Syndrome
LITFL Critical Care Compendium · overview
A brief bedside revision page covering recognition, pathophysiology and treatment principles.
Open resource →