Author information

1. Cleveland Clinic Akron General Medical Center, Akron, OH, United States.
2. Department of Nephrology, Akron Children's Hospital, Akron, OH, United States.
3. Kidney and Renal Transplant Institute, Medanta, The Medicity Hospital, Gurgaon, India.
4. Division of Paediatric Nephrology, Department of Paediatrics, Western University, London, ON, Canada.
5. Division of Pediatric Nephrology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, United States.
6. Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India.
7. Akron Nephrology Associates, Akron, OH, United States.
8. Department of Medicine, Northeast Ohio Medical University, Rootstown, OH, United States.
9. Anne Arundel Medical Center, Annapolis, MD, United States.
10. Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore, Singapore.
11. Department of Pediatrics, ISN-SRC, Pediatric Nephrology, All India Institute of Medical Sciences (AIIMS), Bhopal, India.
12. Department of Paediatric Nephrology, Starship Children's Hospital, Auckland, New Zealand.
13. Pediatrics, Hôtel-Dieu de France Hospital (HDF), Beirut, Lebanon.
14. Pediatric Nephrology Unit, Santa Casa de Belo Horizonte, Belo Horizonte, Brazil.
15. Pediatric Nephrology, King Saud University College of Medicine, Riyadh, Saudi Arabia.
16. Department of Pediatric Critical Care, Akron Children's Hospital, Akron, OH, United States.
17. Department of Pediatric Critical Care, Institute of Liver Transplantation and Regenerative Medicine, Medanta, The Medicity, Gurgaon, India.
18. Klinik für Allgemeine und Thoraxchirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.
19. Department of Pediatric Nephrology, Dr. M R Khan Shishu Hospital & Institute of Child Health, Dhaka, Bangladesh.
20. Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy.
21. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
22. Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY, United States.
23. Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
24. Pediatric Nephrology and Transplantation, Children's Hospital of Richmond, Virginia Commonwealth University (VCU), Richmond, VA, United States.
25. Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
26. Department of Pediatric Nephrology, School of Medicine, Hacettepe University, Ankara, Turkey.
27. Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, United States.

Abstract

Management of acute liver failure (ALF) and acute on chronic liver failure (ACLF) in the pediatric population can be challenging. Kidney manifestations of liver failure, such as hepatorenal syndrome (HRS) and acute kidney injury (AKI), are increasingly prevalent and may portend a poor prognosis. The overall incidence of AKI in children with ALF has not been well-established, partially due to the difficulty of precisely estimating kidney function in these patients. The true incidence of AKI in pediatric patients may still be underestimated due to decreased creatinine production in patients with advanced liver dysfunction and those with critical conditions including shock and cardiovascular compromise with poor kidney perfusion. Current treatment for kidney dysfunction secondary to liver failure include conservative management, intravenous fluids, and kidney replacement therapy (KRT). Despite the paucity of evidence-based recommendations concerning the application of KRT in children with kidney dysfunction in the setting of ALF, expert clinical opinions have been evaluated regarding the optimal modalities and timing of KRT, dialysis/replacement solutions, blood and dialysate flow rates and dialysis dose, and anticoagulation methods.