Renal Failure in Cirrhosis

doi:10.1056/NEJMra0809139

Volume 361:1279-1290		September 24, 2009		Number 13

Renal Failure in Cirrhosis

Pere Ginès, M.D., and Robert W. Schrier, M.D.

Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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PubMed Citation

Renal failure is a challenging complication of cirrhosis¹^,²and is one of the most important risk factors when liver transplantationis being considered. Patients with cirrhosis and renal failureare at high risk for death while awaiting transplantation andhave an increased frequency of complications and reduced survivalafter transplantation, as compared with those without renalfailure.³^,⁴ In 2002, the Model for End-Stage Liver Disease (MELD)score — derived from measurements of serum bilirubin,the international normalized ratio of prothrombin time, andserum creatinine to evaluate pretransplantation renal function— was introduced as an aid to organ allocation among candidates. . . [Full Text of this Article]

Pathophysiology of Renal Failure

Evaluation of Patients with Cirrhosis and Renal Failure

Assessment of Renal Function

General Assessment

Differential Diagnosis of Renal Failure in Cirrhosis

Management of Renal Failure in Cirrhosis

General Measures

Specific Measures

Treatment of Renal Failure

Management of the Hepatorenal Syndrome

Prognosis

Prevention

Renal Failure and Liver Transplantation

Effects of MELD Scoring on Transplantation Outcomes

Patient Survival

Renal Function

Combined Liver and Kidney Transplantation

Summary

Source Information

From the Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, and Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain (P.G.); and the Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Denver, Aurora (R.W.S.).

Address reprint requests to Dr. Schrier at the University of Colorado Health Sciences Center, 12700 E. 19th Ave., C281, Denver, CO 80045, or at robert.schrier@uchsc.edu.