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Acute-on-chronic liver failure (ACLF) comprises a group of clinical syndromes with multiple organ failure and early high mortality. There are differences in the characterization of ACLF between the Eastern and Western medical communities. Patients with ACLF and acute kidney injury (AKI) have more structural injuries, contributing to confusion in diagnosing HRS-AKI. In this review, we discuss progress in the pathogenesis, diagnosis, and management of HRS-AKI, especially in patients with ACLF. Controversy regarding HRS-AKI in ACLF and acute liver failure, hepatic carcinoma, shock, sepsis, and chronic kidney disease is also discussed. Research on the treatment of HRS-AKI with ACLF needs to be more actively pursued to improve disease prognosis.<\/jats:p>","DOI":"10.1093\/gastro\/goab040","type":"journal-article","created":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T11:32:39Z","timestamp":1631100759000},"page":"505-520","source":"Crossref","is-referenced-by-count":17,"title":["Hepatorenal syndrome in acute-on-chronic liver failure with acute kidney injury: more questions requiring discussion"],"prefix":"10.1093","volume":"9","author":[{"given":"Songtao","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China"},{"name":"Department of Severe Liver Disease, Beijing You\u2019an Hospital, Capital Medical University, Beijing, P. R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinghua","family":"Meng","sequence":"additional","affiliation":[{"name":"Department of Severe Liver Disease, Beijing You\u2019an Hospital, Capital Medical University, Beijing, P. R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Beijing Tsinghua Chang Gung Hospital, Beijing, P. R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianxin","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,9,25]]},"reference":[{"key":"2021121701554668700_goab040-B1","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1016\/S0140-6736(03)14903-3","article-title":"Hepatorenal syndrome","volume":"362","author":"Gin\u00e8s","year":"2003","journal-title":"Lancet"},{"key":"2021121701554668700_goab040-B2","doi-asserted-by":"crossref","first-page":"m2687","DOI":"10.1136\/bmj.m2687","article-title":"Hepatorenal syndrome: pathophysiology, diagnosis, and management","volume":"370","author":"Simonetto","year":"2020","journal-title":"BMJ"},{"key":"2021121701554668700_goab040-B3","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/S1665-2681(19)31491-7","article-title":"Causes of renal failure in patients with decompensated cirrhosis and its impact in hospital mortality","volume":"11","author":"Carvalho","year":"2012","journal-title":"Ann 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