Acute Kidney Injury in Alcohol-Associated Hepatitis

Abstract Purpose of Review This review discusses the epidemiology and pathophysiology of acute kidney injury (AKI) in alcohol-associated hepatitis (AH), as well as diagnostic and prognostic implications. We highlight emerging biomarkers, pharmacotherapies, and management strategies. Recent Findings AKI is prevalent in severe AH and primarily due to acute tubular necrosis or prerenal azotemia, with a lesser contribution from hepatorenal syndrome. The presence of AKI portends increased mortality and should prompt an intensive workup. While trial of RRT is warranted, liver transplant provides the most durable survival benefit in this population. Prednisone may reduce the risk of AKI by attenuating systemic inflammation but may also increase the risk of infection. Summary Patients with AH who suffer from AKI are at high risk of mortality, and adequate management requires prompt recognition and treatment of reversible causes, as well as early consideration of liver transplant. Further research is necessary to improve outcomes.