Differential diagnosis of acute kidney injury with cirrhosis
What is the differential diagnosis of acute kidney injury in the patient with cirrhosis?
1. Prerenal azotemia is the most common cause of AKI in hospitalized patients with cirrhosis (approximately one-third of cases). Common causes are over-diuresis, large-volume paracentesis without colloid replacement, or gastrointestinal bleeding. AKI-HRS can be considered a form of prerenal azotemia which is not responsive to volume replacement in advanced cirrhosis with liver dysfunction and ascites.
2. Intrinsic kidney failure occurs in approximately one-third of patients with cirrhosis; most commonly ATN, although systemic conditions, such as glomerulonephritis, also may be present.
3. Postrenal failure occurs in <1% of patients in cirrhosis and results from obstruction to the passage of urine, as seen in a bladder neck obstruction.