Hepatorenal Syndrome - AKI in Decompensated Liver Disease: Clinical Characteristics, Risk Factors, Ultrasound Applications, and Outcomes.

<b>Background.</b> Acute kidney injury (AKI) is a common and serious complication in patients with decompensated liver disease (DLD), often resulting from ischemic acute tubular necrosis or hepatorenal syndrome. This study examines the role of biochemical markers and ultrasound parameters, such as right atrial pressure, right ventricular hypertrophy, inferior vena cava diameter, hepatic venous flow dynamics, left ventricular diastolic dysfunction, the E/e' ratio, renal peak systolic velocity, renal end-diastolic velocity, and renal resistive index (RI), in predicting AKI severity and outcomes. <b>Methods.</b> A prospective observational study was conducted on 50 DLD patients with AKI, admitted to a tertiary care Hospital. Biochemical parameters including serum creatinine, bilirubin, and albumin along with ultrasound parameters were assessed. AKI was classified according to KDIGO criteria, and renal recovery and mortality were monitored. Diagnostic accuracy was evaluated through ROC analysis. <b>Results.</b> 30% of patients had stage 3 AKI, with 60% of them being male (average age 54 ± 12 years). Stage 3 AKI was a significant predictor of mortality (OR 3.5, p < 0.001), along with renal resistive index (OR 2.8, p = 0.003). ROC analysis showed that serum creatinine and the E/e' ratio, along with the RI, were significant predictors for AKI severity and mortality. Renal recovery occurred in 58%. <b>Conclusion.</b> The simultaneous assessment of clinical, biochemical, and ultrasound parameters enhances the prediction of AKI severity and patient outcomes in DLD. This approach facilitates earlier detection and better management of AKI in this population.