There can be many causes of kidney failure in individuals with cirrhosis or fulminant liver failure. Consequently, it is a challenge to distinguish<unk>  from other entities that cause kidney failure in the setting of advanced liver disease. As a result, additional major and minor criteria have been developed to assist in the diagnosis of<unk> . The major criteria include liver disease with portal hypertension; kidney failure; the absence of shock, infection, recent treatment with medications that affect the function of the kidney (nephrotoxins), and fluid losses; the absence of sustained improvement in kidney function despite treatment with 1.5 litres of intravenous normal saline; the absence of proteinuria (protein in the urine); and, the absence of kidney disease or obstruction of kidney outflow as seen on ultrasound. The minor criteria are the following: a low urine volume (less than per day), low sodium concentration in the urine, a urine osmolality that is greater than that in the blood, the absence of red blood cells in the urine, and a serum sodium concentration of less than 130 mmol/L. Many other diseases of the kidney are associated with liver disease and must be excluded before making a diagnosis of<unk> . Individuals with pre-renal kidney failure do not have damage to the kidneys, but as in individuals with<unk> , have kidney dysfunction due to decreased blood flow to the kidneys. Also, similarly to<unk> , pre-renal kidney failure causes the formation of urine that has a very low sodium concentration. In contrast to<unk> , however, pre-renal kidney failure usually responds to treatment with intravenous fluids, resulting in reduction in serum creatinine and increased excretion of sodium. Acute tubular necrosis (ATN) involves damage to the tubules of the kidney, and can be a complication in individuals with cirrhosis, because of exposure to toxic medications or the development of decreased blood pressure. Because of the damage to the tubules, ATN affected kidneys usually are unable to maximally resorb sodium from the urine. As a result, ATN can be distinguished from<unk>  on the basis of laboratory testing, as individuals with ATN will have urine sodium measurements that are much higher than in<unk> ; however, this may not always be the case in cirrhotics. Individuals with ATN also may have evidence of hyaline casts or muddy-brown casts in the urine on microscopy, whereas the urine of individuals with<unk>  is typically devoid of cellular material, as the kidneys have not been directly injured. Some viral infections of the liver, including hepatitis B and hepatitis C can also lead to inflammation of the glomerulus of the kidney. Other causes of kidney failure in individuals with liver disease include drug toxicity (notably, the antibiotic gentamicin) or contrast nephropathy, caused by intravenous administration of contrast agents used for medical imaging tests.
Hepatorenal syndrome
Conorenal syndrome
Papillorenal syndrome
Nephritic syndrome
Cardiorenal syndrome
Hemolytic–uremic syndrome
Dialysis disequilibrium syndrome
Acute uric acid nephropathy