Kidney Disease in the Setting of Liver Failure: Core Curriculum 2013 Thomas A. Gonwa, MD, Hani M. Wadei, MD  American Journal of Kidney Diseases  Volume 62, Issue 6, Pages 1198-1212 (December 2013) DOI: 10.1053/j.ajkd.2013.07.017 Copyright © 2013 National Kidney Foundation, Inc. Terms and Conditions

Figure 1 Mechanisms leading to circulatory and decreased kidney function in cirrhosis. The main mechanism is progressive splanchnic arterial vasodilatation due to overproduction of vasodilator molecules. During the initial phases of decompensated cirrhosis, when activation of vasoconstrictor systems is moderate, patients develop sodium retention and ascites. In subsequent stages, activation of antidiuretic hormone (ADH) leads to dilutional hyponatremia. Finally, in the most advanced phase, when circulatory dysfunction is extreme, renal vasodilatory systems are overcome and patients develop severe renal vasoconstriction and type 2 hepatorenal syndrome (HRS). Abbreviations: RAAS, renin–angiotensin–aldosterone system; SNS, sympathetic nervous system. Reprinted from Arroyo et al (Nature Reviews Nephrology. 2011;7:517-526), with permission of Macmillan Publishers Ltd. American Journal of Kidney Diseases 2013 62, 1198-1212DOI: (10.1053/j.ajkd.2013.07.017) Copyright © 2013 National Kidney Foundation, Inc. Terms and Conditions

Figure 2 Probability of survival of a recent cohort of 116 patients who developed either type 1 (solid line) or type 2 (dotted line) hepatorenal syndrome between April 2007 and February 2009. Adapted from Salerno et al (J Hepatol. 2011;55:1241-1248), with permission of Elsevier. American Journal of Kidney Diseases 2013 62, 1198-1212DOI: (10.1053/j.ajkd.2013.07.017) Copyright © 2013 National Kidney Foundation, Inc. Terms and Conditions

Figure 3 Number of simultaneous liver-kidney transplantations in the United States by year and their percentage of total deceased donor liver transplantations. Health Resources and Services Administration/Organ Procurement and Transplantation Network data as of December 31, 2012. Source www.optn.transplant.hrsa.gov. American Journal of Kidney Diseases 2013 62, 1198-1212DOI: (10.1053/j.ajkd.2013.07.017) Copyright © 2013 National Kidney Foundation, Inc. Terms and Conditions