Acute kidney injury in acute liver failure: a review

Moore, Joanna; Love, Eleanor; Craig, Douglas A.; Hayes, Peter; Simpson, Kenneth J.

doi:10.1586/17474124.2013.837264

Cited by 54 publications

(57 citation statements)

References 71 publications

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“…In comparison, the degree of serum creatinine increase of Ն0.5 mg/dl from baseline appeared to be higher in our patients, with a correspondingly significant decrease in the estimated GFR at week 24. These results might be attributed to a number of pathogenic mechanisms, such as renal hypoperfusion, drug-induced nephrotoxicity, or systemic inflammatory response during severe acute exacerbation of CHB (33). However, there was no significant difference in the estimated GFRs between the TDF and the ETV groups over the treatment course, suggesting that the renal safety of TDF was the same as that of ETV for treating patients with severe acute exacerbation of CHB.…”

Section: Discussionmentioning

confidence: 92%

Tenofovir versus Entecavir in Treatment of Chronic Hepatitis B Virus with Severe Acute Exacerbation

Hung

et al. 2015

Antimicrob Agents Chemother

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bTenofovir disoproxil fumarate (TDF) and entecavir (ETV) are effective antivirals recommended as first-line monotherapies for treatment of chronic hepatitis B (CHB) infection. This study aimed to compare the short-term efficacies of TDF and ETV in the treatment of CHB with severe acute exacerbation. From 2008 to 2013, 189 consecutive treatment-naive CHB patients receiving TDF (n ‫؍‬ 41) or ETV (n ‫؍‬ 148) for severe acute exacerbation were enrolled. The primary endpoint was overall mortality or receipt of liver transplantation by week 24. The baseline characteristics were comparable between these two groups. By week 24, 8 (19% [95% confidence interval {CI}, 7% to 32%]) patients in the TDF group and 26 (18% [95% CI, 11 to 24%]) patients in the ETV group died (n ‫؍‬ 30) or received liver transplantation (n ‫؍‬ 4) (P ‫؍‬ 0.749). The two groups of patients developed similar rates of liver-related complications and achieved comparable biochemical and virological responses at week 24. Cox regression analysis showed that baseline viral DNA level (P ‫؍‬ 0.002), hypertension (P ‫؍‬ 0.002), model for end-stage liver disease (MELD) score (P ‫؍‬ 0.01), platelet count (P ‫؍‬ 0.005), early presence (within 4 weeks) of ascites (P ‫؍‬ 0.005), hepatic encephalopathy (P ‫؍‬ 0.002), and hepatorenal syndrome (P < 0.001) were independent factors for mortality or liver transplantation. Among the patients who survived by week 24, there was no difference between the two groups in the percentage of patients who had a serum creatinine increase of >0.5 mg/dl from baseline (6.7% [95% CI, 0% to 16%] versus 2.0% [95% CI, 0% to 4.8%] in the TDF and ETV groups, respectively; P ‫؍‬ 0.231), whereas a significant reduction in the estimated glomerular filtration rate (eGFR) was found in the two groups (P ‫؍‬ 0.001 for both). In conclusion, TDF and ETV produce a similar treatment response and clinical outcome in patients with severe acute exacerbation of CHB. C hronic hepatitis B virus (HBV) infection is a major global health issue, affecting around 370 million people worldwide (1). Patients with chronic hepatitis B (CHB) are at a significantly increased risk for the development of liver failure, cirrhosis, and hepatocellular carcinoma (HCC) (2). In its natural course, up to 30% of CHB patients experience a spontaneous reactivation of hepatitis every year (3). Severe acute exacerbation of CHB characterized by high serum alanine aminotransferase (ALT) level, jaundice, and hepatic decompensation leads to a high mortality rate, ranging from 30 to 70% (4, 5). Most guidelines recommend treatment with oral nucleos(t)ide analogues (NUCs) for CHB patients with severe acute exacerbation as soon as possible (6-8). Liver transplantation is the salvage treatment if medical therapy fails; however, this is neither readily available nor feasible in many parts of the world where HBV is highly endemic (5, 9). Lamivudine (LAM) was the first effective oral HBV replication-suppressive agent and has been widely used in patients with severe acute exacerbation of CHB (4,...

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Section: Discussionmentioning

confidence: 92%

Tenofovir versus Entecavir in Treatment of Chronic Hepatitis B Virus with Severe Acute Exacerbation

Hung

et al. 2015

Antimicrob Agents Chemother

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“…Cellular Physiology and Biochemistry Cellular Physiology and Biochemistry study, univariate and multivariate logistic analyses revealed that serum PCT concentration was a determinant of high serum Cr levels and low GFR, which indicated that elevated serum PCT might be one of the risk factors of renal injury in HBV-ACLF patients, just like tumour necrosis factor-α, interleukin-6, and interleukin-1 [17]. Furthermore, among the patients with elevated serum PCT (> 0.5 ng/mL), most showed particularly high serum Cr levels and low GFR.…”

Section: Figurementioning

confidence: 98%

Serum Procalcitonin Correlates with Renal Function in Hepatitis B Virus-Related Acute-on-Chronic Liver Failure

Zheng

Liang

Shui

et al. 2018

Cell Physiol Biochem

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Background/Aims: To investigate the relationship between elevated serum procalcitonin (PCT) and renal function in hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods: HBV-ACLF patients (n = 201) presenting to the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University, from January 2013 to November 2016 were categorized into three groups according to serum PCT levels: (i) normal group (n = 74) had PCT of ≤ 0.5 ng/mL; (ii) elevated group (n = 85) had PCT in the range 0.5–1.0 ng/mL; and (iii) highly elevated group (n = 42) had PCT of > 1.0 ng/mL. Thirty-five cases received standard care after admission. Serum PCT levels and renal function were determined during a two-week follow-up. Results: Significant increases in serum creatinine (Cr) were recorded in male and female patients in the elevated group and highly elevated group compared with the normal group (P < 0.05). In addition, serum Cr levels in male and female patients were significantly higher in the highly elevated group than in the elevated group (P < 0.05). The glomerular filtration rate (GFR) was significantly lower in the highly elevated group (P < 0.05) and this group had the highest risk of altered Cr (45.9% in males; 80% in females) and abnormal GFR (37.5%). Serum PCT levels correlated significantly with all renal function parameters including homocysteine (Hcy), GFR, Cr, blood urea nitrogen, uric acid, and cystatin C at baseline and during treatment. Univariate and multivariate analyses indicated that serum PCT was a strong predictor of renal dysfunction. Conclusion: Serum PCT is closely related to renal dysfunction in HBV-ACLF.

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“…Reduction in the effective circulating blood volume and subsequent hypoperfusion of the kidneys may be the possible pathogenesis of renal failure in patients with severe liver failure. 1 It is accompanied by renal vasoconstriction, which leads to a pronounced reduction in glomerular filtration rate (GFR). 2,3 The afferent arteriole has an important role in the regulation of renal blood flow and GFR, thus contributing to the control of extracellular fluid volume and arterial pressure.…”

Section: Introductionmentioning

confidence: 99%

Tumor necrosis factor-alpha-induced reduction of glomerular filtration rate in rats with fulminant hepatic failure

Wang

et al. 2014

Laboratory Investigation

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The mechanism of renal failure during fulminant hepatic failure (FHF) or end-stage of liver disease is not fully understood. The present study aims to delineate the mechanisms of decreased glomerular filtration rate (GFR) in acute hepatic failure. A rat model of renal insufficiency in severe liver injury was established by lipopolysaccharide (LPS) plus D-galactosamine (GalN) exposure. GFR was evaluated by continuous infusion of fluorescein isothiocyanate-inulin with implanted micro-osmotic pumps. GalN/LPS intoxication resulted in severe hepatocyte toxicity as evidenced by liver histology and biochemical tests, whereas renal morphology remained normal. GFR was reduced by 33% of the controls 12 h after GalN/LPS exposure, accompanied with a decreased serum sodium levels, a marked increase in serum TNF-a and ET-1 levels as well as significantly upregulated renal type 1 inositol 1,4,5-trisphosphate receptor (IP 3 R1) expression. The upregulated IP 3 R1 expression was abrogated by the treatment of anti-TNF-a antibodies, but not by 2-aminoethoxydiphenylborate (2-APB), which blocks the inositol 1,4,5-trisphosphate signaling pathway. Treatments with either TNF-a antibodies or 2-APB also significantly improved the compromised GFR, elevated serum urea nitrogen and creatinine levels, and reversed the decrease in glomerular inulin space and the increase in glomerular calcium content in GalN/LPS-exposed rats. The extent of acute liver injury as reflected by serum ALT levels was much more attenuated by anti-TNF-a antibodies than by 2-APB. Liver histology further confirmed that anti-TNF-a antibodies conferred better protection than 2-APB in GalN/LPS-exposed rats. LPS-elicited TNF-a over-production is responsible for decreased GFR through IP 3 R1 overexpression, and the compromised GFR resulted in the development of acute renal failure in rats with FHF.

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Acute kidney injury in acute liver failure: a review

Cited by 54 publications

References 71 publications

Tenofovir versus Entecavir in Treatment of Chronic Hepatitis B Virus with Severe Acute Exacerbation

Tenofovir versus Entecavir in Treatment of Chronic Hepatitis B Virus with Severe Acute Exacerbation

Serum Procalcitonin Correlates with Renal Function in Hepatitis B Virus-Related Acute-on-Chronic Liver Failure

Tumor necrosis factor-alpha-induced reduction of glomerular filtration rate in rats with fulminant hepatic failure

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