**2.4.3 Renal impairment**

*Acute kidney injury* in ALF usually results from impaired renal perfusion or direct renal insults. Hepatorenal syndrome, which occurs in the setting of portal hypertension and chronic liver disease, does not occur in ALF. Management of acute kidney injury includes avoidance of additional nephrotoxic insults, as well as supportive measures. In order to avoid increases in intracranial pressure and significant fluid shifts, if renal replacement therapy is necessary, continuous renal replacement therapy (CRRT) is preferred over conventional hemodialysis.
