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Prognosis of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis: A Prospective Cohort Study.

Allegretti AS, Ortiz G, Wenger J, Deferio JJ, Wibecan J, Kalim S, Tamez H, Chung RT, Karumanchi SA, Thadhani RI - Int J Nephrol (2015)

Bottom Line: Conclusions.Hepatorenal syndrome and acute tubular necrosis result in similar 90-day mortality.Multicenter studies are needed to validate these findings and better guide management.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.

ABSTRACT
Background/Aims. Acute kidney injury is a common problem for patients with cirrhosis and is associated with poor survival. We aimed to examine the association between type of acute kidney injury and 90-day mortality. Methods. Prospective cohort study at a major US liver transplant center. A nephrologist's review of the urinary sediment was used in conjunction with the 2007 Ascites Club Criteria to stratify acute kidney injury into four groups: prerenal azotemia, hepatorenal syndrome, acute tubular necrosis, or other. Results. 120 participants with cirrhosis and acute kidney injury were analyzed. Ninety-day mortality was 14/40 (35%) with prerenal azotemia, 20/35 (57%) with hepatorenal syndrome, 21/36 (58%) with acute tubular necrosis, and 1/9 (11%) with other (p = 0.04 overall). Mortality was the same in hepatorenal syndrome compared to acute tubular necrosis (p = 0.99). Mortality was lower in prerenal azotemia compared to hepatorenal syndrome (p = 0.05) and acute tubular necrosis (p = 0.04). Ten participants (22%) were reclassified from hepatorenal syndrome to acute tubular necrosis because of granular casts on urinary sediment. Conclusions. Hepatorenal syndrome and acute tubular necrosis result in similar 90-day mortality. Review of urinary sediment may add important diagnostic information to this population. Multicenter studies are needed to validate these findings and better guide management.

No MeSH data available.


Related in: MedlinePlus

Percentage of participants with acute kidney injury who failed to satisfy Ascites Club Criteria for hepatorenal syndrome. PRA (prerenal azotemia), ATN (acute tubular necrosis).
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fig3: Percentage of participants with acute kidney injury who failed to satisfy Ascites Club Criteria for hepatorenal syndrome. PRA (prerenal azotemia), ATN (acute tubular necrosis).

Mentions: Each of the six components of the Ascites Club Criteria was analyzed in the PRA, ATN, and “other” AKI subgroups to determine how each participant failed to meet diagnostic criteria for HRS (Figure 3). In the ATN subgroup, participants most commonly had evidence of parenchymal renal disease (55%) or shock (33%). In the PRA subgroup, participants most commonly had a serum creatinine lower than 1.5 mg/dL (20%), had a reduction of creatinine below 1.5 mg/dL with albumin and holding diuretics (55%), or had shock (20%). In the subgroup of “other” causes of AKI, participants most commonly had evidence of parenchymal renal disease (56%) or exposure to nephrotoxic drugs (22%).


Prognosis of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis: A Prospective Cohort Study.

Allegretti AS, Ortiz G, Wenger J, Deferio JJ, Wibecan J, Kalim S, Tamez H, Chung RT, Karumanchi SA, Thadhani RI - Int J Nephrol (2015)

Percentage of participants with acute kidney injury who failed to satisfy Ascites Club Criteria for hepatorenal syndrome. PRA (prerenal azotemia), ATN (acute tubular necrosis).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4525763&req=5

fig3: Percentage of participants with acute kidney injury who failed to satisfy Ascites Club Criteria for hepatorenal syndrome. PRA (prerenal azotemia), ATN (acute tubular necrosis).
Mentions: Each of the six components of the Ascites Club Criteria was analyzed in the PRA, ATN, and “other” AKI subgroups to determine how each participant failed to meet diagnostic criteria for HRS (Figure 3). In the ATN subgroup, participants most commonly had evidence of parenchymal renal disease (55%) or shock (33%). In the PRA subgroup, participants most commonly had a serum creatinine lower than 1.5 mg/dL (20%), had a reduction of creatinine below 1.5 mg/dL with albumin and holding diuretics (55%), or had shock (20%). In the subgroup of “other” causes of AKI, participants most commonly had evidence of parenchymal renal disease (56%) or exposure to nephrotoxic drugs (22%).

Bottom Line: Conclusions.Hepatorenal syndrome and acute tubular necrosis result in similar 90-day mortality.Multicenter studies are needed to validate these findings and better guide management.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.

ABSTRACT
Background/Aims. Acute kidney injury is a common problem for patients with cirrhosis and is associated with poor survival. We aimed to examine the association between type of acute kidney injury and 90-day mortality. Methods. Prospective cohort study at a major US liver transplant center. A nephrologist's review of the urinary sediment was used in conjunction with the 2007 Ascites Club Criteria to stratify acute kidney injury into four groups: prerenal azotemia, hepatorenal syndrome, acute tubular necrosis, or other. Results. 120 participants with cirrhosis and acute kidney injury were analyzed. Ninety-day mortality was 14/40 (35%) with prerenal azotemia, 20/35 (57%) with hepatorenal syndrome, 21/36 (58%) with acute tubular necrosis, and 1/9 (11%) with other (p = 0.04 overall). Mortality was the same in hepatorenal syndrome compared to acute tubular necrosis (p = 0.99). Mortality was lower in prerenal azotemia compared to hepatorenal syndrome (p = 0.05) and acute tubular necrosis (p = 0.04). Ten participants (22%) were reclassified from hepatorenal syndrome to acute tubular necrosis because of granular casts on urinary sediment. Conclusions. Hepatorenal syndrome and acute tubular necrosis result in similar 90-day mortality. Review of urinary sediment may add important diagnostic information to this population. Multicenter studies are needed to validate these findings and better guide management.

No MeSH data available.


Related in: MedlinePlus