# Liver Disease for Nephrology: Pattern, Function, Complications

Read liver injury, cholestasis, and synthetic function separately before explaining associated AKI.

![Infographic: Liver Disease for Nephrology: Pattern, Function, Complications](https://urinenephrology.org/visual-reference/images/student-liver-kidney-overview.png?v=20261003c)

## Classify the biochemical pattern

Predominant AST/ALT elevation suggests hepatocellular injury; disproportionate alkaline phosphatase suggests cholestasis. Confirm the source of alkaline phosphatase when uncertain and review bilirubin, medication exposure, alcohol, and viral risks.

## Injury enzymes are not liver function

Albumin and INR help assess synthetic function but have confounders: nutrition/inflammation affect albumin; anticoagulants and vitamin K deficiency affect INR. Normal aminotransferases do not exclude advanced chronic liver disease.

## Identify decompensation

New ascites, variceal bleeding, encephalopathy, or jaundice requires prompt liver-focused evaluation. Infection, bleeding, and drug effects can precipitate deterioration and simultaneously cause AKI.

## AKI in cirrhosis has several causes

Assess volume loss, infection, nephrotoxins, obstruction, glomerular disease, and tubular injury before assigning HRS-AKI. Review urine sediment/protein and prior renal function; low urine sodium alone cannot establish HRS.

## Make fluid decisions from the examination

A patient can have ascites but low effective arterial perfusion, or true intravascular congestion. Use hemodynamics and volume assessment; neither routine large fluid loading nor automatic diuretic escalation is appropriate for every creatinine rise.

## Worked example

Cirrhosis plus diarrhea and rising creatinine first demands assessment of losses, perfusion, infection, and drugs. Treating it immediately as hepatorenal syndrome can miss a reversible trigger and expose the patient to unnecessary therapy.

## Source lessons

- [hepatology overview student handout](https://urinenephrology.org/student-resources/hepatorenal/hepatology-overview-student-handout.html)

Read alongside the full lessons; the findings and decisions shown here require the stated clinical context.