Acute-on-chronic Liver Failure With Acute Kidney Injury:a Case Analysis And Literature Review

Objective: End-stage of liver disease(ESLD)refers to the late stage various chronic liver diseases including decompensated cirrhosis,liver failure and hepatocellular carcinoma,which caused by a series of injury factors.Acute kidney injury(AKI)is a common and serious complication of ESLD,which is mainly characterized by decreased glomerular filtration rate(GFR),rapid increase of serum creatinine(SCr),and oliguria or anuria.Hepatorenal syndrome-acute kidney injury(HRS-AKI)is a specific clinical type of AKI with high risk of death.Therefore,it is particularly important to realize the timely identification,diagnosis and treatment of HRS-AKI to improve the prognosis of patients.By retrospectively analyzing the clinical diagnosis and treatment of a patient with chronic-on-acute liver failure(ACLF)complicated with AKI,this article reviewed the latest diagnostic criteria,classification,pathogenesis,diagnostic process,and treatment methods of ESLD with AKI,in order to improve clinicians’ understanding of the disease and improve the prognosis of patients.Methods: The clinical data of a patient with ACLF complicated with AKI who was admitted to the Department of Infectious Disease,the Third Affiliated Hospital of Hebei Medical University were retrospectively analyzed.The diagnosis,pathogenesis,treatment and prevention of ESLD with AKI,especially HRS-AKI,were summarized in combination with relevant domestic and foreign literatures.Results: The enrolled patient was diagnosed with hepatitis B virus(HBV)related acute-on-chronic liver failure(HBV-ACLF).During hospitalization,HRS-AKI occurred due to alteration of intestinal flora and antibioticassociated diarrhea.By controlling the ACLF,anti-infection,regulating intestinal flora and infusing terlipressin combined with albumin,the condition improved and the liver and renal biomarker returned to normal.Conclusions: AKI is a serious complication of ESLD,with high mortality.The key to improve the prognosis of patients with ESLD complicated with AKI is early identification of the etiology and inducement,timely determination of the type and degree and targeted treatment of AKI.Terlipressin,as the representative of vasopressin,combined with albumin is the first-line therapeutic drugs to HRS-AKI,which can reverse the renal function in most patients and improve the short-term survival rate.However,liver transplantation is still the best treatment for end stage liver disease with HRS-AKI up to now.