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Acute Kidney Injury in Patients with Cirrhosis.

Russ KB, Stevens TM, Singal AK - J Clin Transl Hepatol (2015)

Bottom Line: The most common causes of AKI in cirrhosis include prerenal injury, acute tubular necrosis (ATN), and the hepatorenal syndrome (HRS), accounting for more than 80% of AKI in this population.Distinguishing between these causes is particularly important for prognostication and treatment.In this regard, novel serum and/or urinary biomarkers such as neutrophil gelatinase-associated lipocalin, interleukins-6 and 18, kidney injury molecule-1, fatty acid binding protein, and endothelin-1 are emerging with a potential for accurately differentiating common causes of AKI.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, UAB, Birmingham, AL, USA.

ABSTRACT
Acute kidney injury (AKI) occurs commonly in patients with advanced cirrhosis and negatively impacts pre- and post-transplant outcomes. Physiologic changes that occur in patients with decompensated cirrhosis with ascites, place these patients at high risk of AKI. The most common causes of AKI in cirrhosis include prerenal injury, acute tubular necrosis (ATN), and the hepatorenal syndrome (HRS), accounting for more than 80% of AKI in this population. Distinguishing between these causes is particularly important for prognostication and treatment. Treatment of Type 1 HRS with vasoconstrictors and albumin improves short term survival and renal function in some patients while awaiting liver transplantation. Patients with HRS who fail to respond to medical therapy or those with severe renal failure of other etiology may require renal replacement therapy. Simultaneous liver kidney transplant (SLK) is needed in many of these patients to improve their post-transplant outcomes. However, the criteria to select patients who would benefit from SLK transplantation are based on consensus and lack strong evidence to support them. In this regard, novel serum and/or urinary biomarkers such as neutrophil gelatinase-associated lipocalin, interleukins-6 and 18, kidney injury molecule-1, fatty acid binding protein, and endothelin-1 are emerging with a potential for accurately differentiating common causes of AKI. Prospective studies are needed on the use of these biomarkers to predict accurately renal function recovery after liver transplantation alone in order to optimize personalized use of SLK.

No MeSH data available.


Related in: MedlinePlus

Management approach and algorithm for acute kidney injury in patients with cirrhosis.ESLD, end-stage liver disease; AKI, acute kidney injury; USG, ultrasonogram; LVP, large volume paracentesis; HRS, hepatorenal syndrome; TIPS, transjugular intrahepatic portosystemic shunt; RRT, renal replacement therapy; LTA, liver transplant alone; SLK, simultaneous liver kidney.
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f02: Management approach and algorithm for acute kidney injury in patients with cirrhosis.ESLD, end-stage liver disease; AKI, acute kidney injury; USG, ultrasonogram; LVP, large volume paracentesis; HRS, hepatorenal syndrome; TIPS, transjugular intrahepatic portosystemic shunt; RRT, renal replacement therapy; LTA, liver transplant alone; SLK, simultaneous liver kidney.

Mentions: AKI can occur due to prerenal, intrarenal, or postrenal causes.3,26 Of these, prerenal etiology is the most common cause of AKI among patients with cirrhosis followed by ATN, while the postrenal etiology due to urinary tract obstruction is extremely rare (Fig. 2). In a retrospective study of 423 patients with cirrhosis admitted to the hospital with a diagnosis of AKI, prerenal and ATN accounted for over 80% of cases (49% prerenal; 35% ATN).27 Postrenal injury accounted for only 0.2% of cases in this study.27 In our prospective study, among 109 patients with cirrhosis listed for liver transplantation who had AKI, prerenal injury was the most common cause in 76 followed by intrarenal etiology in 33, while postrenal etiology did not occur in any patient.15


Acute Kidney Injury in Patients with Cirrhosis.

Russ KB, Stevens TM, Singal AK - J Clin Transl Hepatol (2015)

Management approach and algorithm for acute kidney injury in patients with cirrhosis.ESLD, end-stage liver disease; AKI, acute kidney injury; USG, ultrasonogram; LVP, large volume paracentesis; HRS, hepatorenal syndrome; TIPS, transjugular intrahepatic portosystemic shunt; RRT, renal replacement therapy; LTA, liver transplant alone; SLK, simultaneous liver kidney.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663201&req=5

f02: Management approach and algorithm for acute kidney injury in patients with cirrhosis.ESLD, end-stage liver disease; AKI, acute kidney injury; USG, ultrasonogram; LVP, large volume paracentesis; HRS, hepatorenal syndrome; TIPS, transjugular intrahepatic portosystemic shunt; RRT, renal replacement therapy; LTA, liver transplant alone; SLK, simultaneous liver kidney.
Mentions: AKI can occur due to prerenal, intrarenal, or postrenal causes.3,26 Of these, prerenal etiology is the most common cause of AKI among patients with cirrhosis followed by ATN, while the postrenal etiology due to urinary tract obstruction is extremely rare (Fig. 2). In a retrospective study of 423 patients with cirrhosis admitted to the hospital with a diagnosis of AKI, prerenal and ATN accounted for over 80% of cases (49% prerenal; 35% ATN).27 Postrenal injury accounted for only 0.2% of cases in this study.27 In our prospective study, among 109 patients with cirrhosis listed for liver transplantation who had AKI, prerenal injury was the most common cause in 76 followed by intrarenal etiology in 33, while postrenal etiology did not occur in any patient.15

Bottom Line: The most common causes of AKI in cirrhosis include prerenal injury, acute tubular necrosis (ATN), and the hepatorenal syndrome (HRS), accounting for more than 80% of AKI in this population.Distinguishing between these causes is particularly important for prognostication and treatment.In this regard, novel serum and/or urinary biomarkers such as neutrophil gelatinase-associated lipocalin, interleukins-6 and 18, kidney injury molecule-1, fatty acid binding protein, and endothelin-1 are emerging with a potential for accurately differentiating common causes of AKI.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, UAB, Birmingham, AL, USA.

ABSTRACT
Acute kidney injury (AKI) occurs commonly in patients with advanced cirrhosis and negatively impacts pre- and post-transplant outcomes. Physiologic changes that occur in patients with decompensated cirrhosis with ascites, place these patients at high risk of AKI. The most common causes of AKI in cirrhosis include prerenal injury, acute tubular necrosis (ATN), and the hepatorenal syndrome (HRS), accounting for more than 80% of AKI in this population. Distinguishing between these causes is particularly important for prognostication and treatment. Treatment of Type 1 HRS with vasoconstrictors and albumin improves short term survival and renal function in some patients while awaiting liver transplantation. Patients with HRS who fail to respond to medical therapy or those with severe renal failure of other etiology may require renal replacement therapy. Simultaneous liver kidney transplant (SLK) is needed in many of these patients to improve their post-transplant outcomes. However, the criteria to select patients who would benefit from SLK transplantation are based on consensus and lack strong evidence to support them. In this regard, novel serum and/or urinary biomarkers such as neutrophil gelatinase-associated lipocalin, interleukins-6 and 18, kidney injury molecule-1, fatty acid binding protein, and endothelin-1 are emerging with a potential for accurately differentiating common causes of AKI. Prospective studies are needed on the use of these biomarkers to predict accurately renal function recovery after liver transplantation alone in order to optimize personalized use of SLK.

No MeSH data available.


Related in: MedlinePlus