AKI in ACLF: navigating the complex therapeutic puzzle.

IF 3.8 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Expert Review of Gastroenterology & Hepatology Pub Date : 2025-01-23 DOI:10.1080/17474124.2025.2456121

Rakhi Maiwall, Fagun Sharma

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Abstract

Introduction: Acute kidney injury (AKI) in patients with acute-on-chronic liver failure (ACLF) is driven by the severity of systemic inflammation, acute portal hypertension driving circulatory dysfunction, hyperbilirubinemia, and toxicity of bile acids. The spectrum is mostly structural, associated with reduced response to vasoconstrictors. The progression is rapid, and need of renal replacement therapy and extracorporeal therapies may be required for the management. The development of renal failure is usually considered when defining the syndrome of ACLF.

Areas covered: In the current review we discuss the pathophysiological basis, natural course, and response to the current therapeutic modalities and challenges in assessing and managing AKI in patients with ACLF. We conducted a comprehensive search of electronic databases such as PubMed, Web of Science, and Scopus using keywords like lactate, NGAL, and PHTN, as well as CRRT, PLEX, ACLF, and AKI phases for our review. Peer-reviewed English papers that addressed our issue were considered.

Expert opinion: The difficulties and specific management strategies for AKI in ACLF patients are discussed emphasizing the importance of customized protocols, risk assessment guided by biomarkers, and investigation of extracorporeal therapies that target bile acids.

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ACLF的AKI：导航复杂的治疗难题。

急性慢性肝功能衰竭（ACLF）患者的急性肾损伤（AKI）是由全身炎症的严重程度、急性门脉高压导致循环功能障碍、高胆红素血症和胆汁酸毒性驱动的。频谱主要是结构性的，与对血管收缩剂的反应减弱有关。病情进展迅速，可能需要肾脏替代治疗和体外治疗。在定义ACLF综合征时，通常考虑肾功能衰竭的发展。涵盖领域：在当前的综述中，我们讨论了评估和管理ACLF患者AKI的病理生理基础，自然过程，以及对当前治疗方式的反应和挑战。我们对PubMed、Web of Science和Scopus等电子数据库进行了全面的检索，使用了乳酸、NGAL和PHTN等关键词，以及CRRT、PLEX、ACLF和AKI阶段进行综述。讨论我们问题的同行评议的英文论文被考虑在内。专家意见：讨论了ACLF患者AKI的困难和具体管理策略，强调了定制方案的重要性，生物标志物指导的风险评估，以及针对胆汁酸的体外治疗的研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Gastroenterology & Hepatology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

6.80

自引率

2.60%

发文量

审稿时长

6-12 weeks

期刊介绍： The enormous health and economic burden of gastrointestinal disease worldwide warrants a sharp focus on the etiology, epidemiology, prevention, diagnosis, treatment and development of new therapies. By the end of the last century we had seen enormous advances, both in technologies to visualize disease and in curative therapies in areas such as gastric ulcer, with the advent first of the H2-antagonists and then the proton pump inhibitors - clear examples of how advances in medicine can massively benefit the patient. Nevertheless, specialists face ongoing challenges from a wide array of diseases of diverse etiology.

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