Review article: current management of renal dysfunction in the cirrhotic patient

The United Network for Organ Sharing database revealed that over the last 4-5 years, an average of 1800 patients were removed from the cadaveric waiting list annually because of patients' death and an additional 400-500 were removed from the list because of the severity of their illnesses.(1) The pre-transplant evaluation process, therefore, requires careful and continued assessment of the patient's pulmonary, cardiac and renal function among others. This article describes a systematic approach to the evaluation and management of renal dysfunction complicating the course of advanced liver disease, the pathogenic mechanisms and current recommendations for the treatment of hepatorenal syndrome, and the indications for combined liver-kidney transplantation.