Liver disease and renal dysfunction

Renal dysfunction frequently complicates liver disease and, when present, adversely affects prognosis. While a number of conditions can affect both the liver and the kidney acutely (e.g. paracetamol), many hepatotoxic insults (e.g. alcohol or viral hepatitis) cause more problems associated with cirrhosis. This review focuses mainly on the renal dysfunction associated with this chronic liver damage. Chronic liver disease is implicated in changes in vascular reactivity and tone, resulting in a systemic vasodilatation and renal vasoconstriction. In its extreme form it leads to the most feared of all renal complications of liver disease, the hepatorenal syndrome (HRS), which is frequently fatal. The recognition and early management of both the renal dysfunction and liver disease are important to survival. The key therapeutic issues revolve around optimizing the circulating volume, reversing the maladaptive haemodynamic changes, removal of other potential nephrotoxins and early treatment of infection.