**14. Hepatorenal syndrome**

Patients with advanced cirrhosis frequently show some degree of renal dysfunction, and there is a strong relationship between the severity of cirrhosis and renal dysfunction. It has been estimated that more than 20% of patients hospitalized for acute decompensation of cirrhosis develop acute kidney injury. Cirrhotic patients can develop any type of renal failure, that is, prerenal (41.7%), intrarenal (38%), and postrenal (0.3%) types [57, 58].

Hepatorenal syndrome (HRS) is a peculiar type of functional AKI described in advanced liver disease with ascites and is characterized by vasoconstriction that does not improve with volume replacement. Hepatorenal syndrome accounts for 20% of AKI in patients with cirrhosis. The incidence of HRS in the natural history of cirrhosis is 18% after 1 year and 39% after 5 years [59].

AKI in the cirrhosis spectrum is defined using the KDIGO criteria, and the international ascites club introduces this definition of serum creatinine increase of ≥0.3 mg/ dL within 48 hours in hospitalized patients or an increase of ≥50% in 7 days [60].

The multiple mechanisms that condition this pathology, and the following mechanisms are mentioned:


### *Artificial Liver Support Systems DOI: http://dx.doi.org/10.5772/intechopen.109843*

