Treatment measures for Acute Kidney Injury with cirrhosis

What are some general treatment measures for AKI in patients with cirrhosis?

• Treat infection

• Discontinue nephrotoxic medications, including nonsteroidal anti-inflammatory drugs

• Discontinue angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. In patients with decompensated cirrhosis, the RAAS is vital to maintaining arterial pressure and GFR in the face of marked splanchnic and systemic vasodilatation. Inhibition of the RAAS may precipitate hypotension and deterioration of kidney function.

• Assess and correct effective circulating volume: While excess total body water is present in decompensated cirrhosis, it usually extravasates intra-abdominally or into peripheral tissue, and patients are still intravascularly deplete.

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