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Pathophysiology of renal impairment in patients with acute decompensation of cirrhosis from HbSS. Mechanisms include (1) SCIC leading to acute tubular necrosis and direct injury from haemoglobinuria, and (2) HRS (ASHC, acute sickle hepatic crisis; HbSS, sickle cell anaemia; HRS, hepatorenal syndrome; HTN, hypertension; NO, nitric oxide; RAAS, renin-angiotensin-aldosterone system; RBCs, red blood cells; SCIC, sickle cell intrahepatic cholestasis).
