Novel biomarkers may assist in identification of acute tubular necrosis and persistent/severe acute kidney injury (AKI). Norepinephrine has been suggested to be inferior to terlipressin, with additional research required. Increasing acute-on-chronic liver failure grade correlates with lower likelihood of vasopressor response in hepatorenal syndrome (HRS). Severe pre-liver transplantation AKI confers significantly worse post-liver transplantation renal outcomes. Biomarkers (neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, interleukin-18, and liver-type fatty acid-binding protein) may assist in the identification of underlying acute tubular necrosis. Of these, neutrophil gelatinase-associated lipocalin is the most promising; however, significant overlap occurs among AKI phenotypes, with diagnostic values yet to be defined.

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