Acute kidney injury and hepatorenal syndrome in cirrhosis

Acute kidney injury(AKI)in cirrhosis,including hepatorenal syndrome(HRS),is a common and serious complication in cirrhotic patients,leading to significant morbidity and mortality.AKI is separated into two categories,non-HRS AKI and HRS-AKI.The most recent definition and diagnostic criteria of AKI in cirrhosis and HRS have helped diagnose and prognosticate the disease.The pathophysiology behind non-HRS-AKI and HRS is more complicated than once theorized and involves more processes than just splanchnic vasodilation.The common biomarkers clinicians use to assess kidney injury have significant limitations in cirrhosis patients;novel biomarkers being studied have shown promise but require further studies in clinical settings and animal models.The overall management of non-HRS AKI and HRS-AKI requires a systematic approach.Although pharmacological treatments have shown mortality benefit,the ideal HRS treatment option is liver transplantation with or without simultaneous kidney transplantation.Further research is required to optimize pharmacologic and nonpharmacologic approaches to treatment.This article reviews the current guidelines and recommendations of AKI in cirrhosis.

COVID-19 status quo:Emphasis on gastrointestinal and liver manifestations

The coronavirus disease 2019(COVID-19)has caused one of the worst public health crises in modern history.Even though severe acute respiratory syndrome coronavirus 2 primarily affects the respiratory tract,gastrointestinal manifestations are well described in literature.This review will discuss the epidemiology,virology,manifestations,immunosuppressant states,and lessons learned from COVID-19.Observations:At the time of writing,COVID-19 had infected more than 111 million people and caused over 2.5 million deaths worldwide.Multiple medical comorbidities including obesity,pre-existing liver condition and the use of proton pump inhibitor have been described as risk factor for severe COVID-19.COVID-19 most frequently causes diarrhea(12.4%),nausea/vomiting(9%)and elevation in liver enzymes(15%-20%).The current data does not suggest that patients on immunomodulators have a significantly increased risk of mortality from COVID-19.The current guidelines from American Gastroenterological Association and American Association for the Study of Liver Diseases do not recommend pre-emptive changes in patients on immunosuppression if the patients have not been infected with COVID-19.Conclusions and relevance:The COVID-19 pandemic has prompted a change in structure and shape of gastroenterology departmental activities.Endoscopy should be performed only when necessary and with strict protective measures.Online consultations in the form of telehealth services and home drug deliveries have revolutionized the field.