AKI is commonly encountered in patients with decompensated cirrhosis, and it is associated with unfavorable outcomes. Among factors specific to cirrhosis, hepatorenal syndrome type 1, also referred to as hepatorenal syndrome-AKI, is the most salient and unique etiology. Patients with cirrhosis are vulnerable to traditional causes of AKI, such as prerenal azotemia, acute tubular injury, and acute interstitial nephritis. In addition, other less common etiologies of AKI specifically related to chronic liver disease should be considered, including abdominal compartment syndrome, cardiorenal processes linked to cirrhotic cardiomyopathy and portopulmonary hypertension, and cholemic nephropathy. Furthermore, certain types of GN can cause AKI in cirrhosis, such as IgA nephropathy or viral hepatitis related. Therefore, a comprehensive diagnostic approach is needed to evaluate patients with cirrhosis presenting with AKI. Management should be tailored to the specific underlying etiology. Albumin-based volume resuscitation is recommended in prerenal AKI. Acute tubular injury and acute interstitial nephritis are managed with supportive care, withdrawal of the offending agent, and, potentially, corticosteroids in acute interstitial nephritis. Short of liver transplantation, vasoconstrictor therapy is the primary treatment for hepatorenal syndrome type 1. Timing of initiation of vasoconstrictors, the rise in mean arterial pressure, and the degree of cholestasis are among the factors that determine vasoconstrictor responsiveness. Large-volume paracentesis and diuretics are indicated to relieve intra-abdominal hypertension and renal vein congestion. Direct-acting antivirals with or without immunosuppression are used to treat hepatitis B/C–associated GN. In summary, AKI in cirrhosis requires careful consideration of multiple potentially pathogenic factors and the implementation of targeted therapeutic interventions.

AKI 常见于失代偿性肝硬化患者，并且与不良结局相关。在肝硬化特有因素中，1 型肝肾综合征（也称为肝肾综合征 -AKI）是最突出和独特的病因。肝硬化患者容易受到 AKI 的传统病因的影响，例如肾前性氮质血症、急性肾小管损伤和急性间质性肾炎。此外，还应考虑与慢性肝病特别相关的其他不太常见的 AKI 病因，包括腹腔间隔室综合征、与肝硬化心肌病和门脉性肺动脉高压相关的心肾病变，以及胆汁性肾病。此外，某些类型的 GN 可导致肝硬化 AKI，例如 IgA 肾病或病毒性肝炎相关。因此，需要一种全面的诊断方法来评估出现 AKI 的肝硬化患者。管理应根据具体的潜在病因进行调整。对于肾前性 AKI，建议进行基于白蛋白的容量复苏。急性肾小管损伤和急性间质性肾炎的治疗方法包括支持治疗、停用致病药物以及可能的急性间质性肾炎皮质类固醇。除肝移植外，血管收缩剂治疗是 1 型肝肾综合征的主要治疗方法。血管收缩剂开始使用的时机、平均动脉压的升高和胆汁淤积的程度是决定血管收缩剂反应性的因素。大容量腹腔穿刺术和利尿剂可缓解腹内高压和肾静脉充血。联合或不联合免疫抑制的直接作用抗病毒药物用于治疗乙型/丙型肝炎相关的肾小球肾炎。 综上所述，肝硬化AKI需要仔细考虑多种潜在致病因素并实施针对性的治疗干预措施。