Causes of kidney impairment in patients with cirrhosis

Kidney impairment is common in patients with cirrhosis. It is often multifactorial, and can significantly affect survival.

Acute kidney injury in patients with cirrhosis can be caused by hypovolaemia (eg from bleeding, diuretics or diarrhoea), acute tubular necrosis, sepsis, nephrotoxins (eg aminoglycosides, nonsteroidal anti-inflammatory drugs [NSAIDs], contrast agents) or type 1 hepatorenal syndrome (now known as ‘hepatorenal syndrome—acute kidney injury’ [HRS-AKI]).

Common causes of chronic kidney disease in patients with cirrhosis include diabetes, hypertension, chronic viral hepatitis, immunoglobulin A (IgA) nephropathy and type 2 hepatorenal syndrome (now known as ‘hepatorenal syndrome—no acute kidney injury’ [HRS-NAKI]).