AKI in a Patient with Cirrhosis and Ascites

Davenport, Andrew

doi:10.2215/cjn.03390412

Cited by 16 publications

(18 citation statements)

References 36 publications

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“…When this criterion was added to the multivariate model of death prediction, no improvement of the model predictive capacity was seen [23] . Taken together, these studies suggest that using the AKIN classification to detect and assess AKI might have a clinical interest, for example by favouring early recognition of HRS (whereas current diagnostic criteria require a SCr above 1.5 mg/dL) [13] . However, they also suggest that other parameters could be taken into account, in order to strengthen the clinical relevance of this classification, such as peak SCr level or the progression of the AKI severity during hospitalisation.…”

Section: Definition Of Akimentioning

confidence: 94%

“…Otherwise, the renal vasoconstriction tends to worsen due to the persistent secretion of several vasoconstrictors and also to an increased sensitivity of the kidney to these vasoconstrictors. Finally, a disturbance of the renal autoregulation also takes place in this context [13] . All these factors explain the extreme sensitivity of the renal function to the changes of volemia.…”

Section: Studies That Tested the Rifle/ Akin Classification In Cirrhomentioning

confidence: 98%

“…In the context of cirrhosis or acute liver failure, several modifications of the renal perfusion, induced by PH, occur which considerably increase the sensitivity of the renal perfusion and the GFR to the changes in volemia. These are responsible for a decline in the GFR, even if only minor variations of extracellular fluid take place [11,13] . Moreover, these hemodynamic modifications may be accompanied by renal tissue injury related to the renal toxicity of a very high concentration of serum bilirubin, which can promote the development of AKI [14,15] .…”

Section: Aki and Ldsmentioning

confidence: 99%

“…The mechanisms involved in the occurrence of AKI in cirrhosis have been extensively studied and are described in several review papers over the past 10 years [10,11,13,16] . Briefly, the primum movens of this disorder is related to the PH, which causes a decrease of effective arterial blood volume by inducing a large splanchnic vasodilation.…”

Section: Factors Favouring the Occurrence Of Aki In Cirrhosismentioning

confidence: 99%

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Acute kidney injury in patients with chronic liver disease

Rognant¹

2015

WJH

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Acute kidney injury (AKI) is a frequent clinical event in patients with liver disease, compounding their prognosis. Furthermore, it is likely that the occurrence of AKI has a detrimental impact on the subsequent renal function and the long-term survival of these patients. Recently, some authors advocated the use of new diagnostic criteria for detecting acute kidney injury in patients with cirrhosis. These criteria are based on the rapidity and extent of the creatinine increase comparing to the basal creatinine and also on the kinetics of diuresis decrease. Although their validity in this population requires further studies to be clearly established, these new criteria could have two advantages: (1) to allow earlier diagnosis of AKI and, thus, hepatorenal syndrome for which earlier intervention could improve patients' survival; and (2) to promote more intensive monitoring of renal function in these patients with high risk of AKI. Finally, recent practice guidelines about the prevention and treatment of general AKI have been published which should be useful in optimising the management of AKI in cirrhotic patients.

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Section: Definition Of Akimentioning

confidence: 94%

Section: Studies That Tested the Rifle/ Akin Classification In Cirrhomentioning

confidence: 98%

Section: Aki and Ldsmentioning

confidence: 99%

Section: Factors Favouring the Occurrence Of Aki In Cirrhosismentioning

confidence: 99%

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Acute kidney injury in patients with chronic liver disease

Rognant¹

2015

WJH

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“…However serum creatinine estimations typically over estimate "true" renal function pre-operatively [11] , and then under estimate renal function post-operatively so potentially increasing the reported incidence of AKI.…”

Section: Current Definitions Of Acute Kidney Injurymentioning

confidence: 99%

Difficulties in diagnosing acute kidney injury post liver transplantation using serum creatinine based diagnostic criteria

Agarwal

Davenport

2014

WJH

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Renal function in patients with advanced cirrhosis is an important prognostic factor for survival both prior to and following liver transplantation. The importance of renal function is reflected by the introduction of the model for end stage liver disease (MELD) score, which includes serum creatinine. The MELD score has been shown to predict the short term risk of death for transplant wait listed patients and is currently used by many countries to allocate liver transplants on the basis of severity of underlying illness. Changes in serum creatinine are also used to stage acute kidney injury. However prior to liver transplantation the serum creatinine typically over estimates underlying renal function, particularly when a colorimetric Jaffe based assay is used, and paradoxically then under estimates renal function post liver transplantation, particularly when immunophyllins are started early as part of transplant immunosuppression. As acute kidney injury is defined by changes in serum creatinine, this potentially leads to over estimation of the incidence and severity of acute kidney injury in the immediate post-operative period. Key words: Serum creatinine; Acute kidney injury; Liver transplantationCore tip: Acute kidney injury is defined and severity graded based on changes in serum creatinine. Increasing concentrations of bilirubin interefere with laboratory determination of creatinine and reduce creatinine estimations. Post transplantation serum creatinine increases due to a combination of fall bilirubin and the loading doses of calcineurin inhibitor immunosupressants. This combination leads to an over estimation of the lesser grades of acute kidney injury post liver transplantation.Agarwal B, Davenport A. Difficulties in diagnosing acute kidney injury post liver transplantation using serum creatinine based diagnostic criteria. World J Hepatol 2014; 6(10): 696-703 Available from:

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Neutrophil Gelatinase‐Associated Lipocalin for Assessment of Acute Kidney Injury in Cirrhosis: A Prospective Study

et al. 2019

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Kidney biomarkers appear to be useful in differential diagnosis between acute tubular necrosis (ATN) and other types of acute kidney injury (AKI) in cirrhosis, particularly hepatorenal syndrome (HRS-AKI). Distinction is important because treatment is different. However, kidney biomarkers are still not used in clinical practice. The aim of the current study was to investigate the accuracy of several biomarkers in differential diagnosis of AKI and in predicting kidney outcome and patient survival. This was a prospective study of 320 consecutive cases of AKI in patients hospitalized for decompensated cirrhosis. Evaluation of AKI was made with a diagnostic algorithm that included identification and removal/treatment of precipitating factors and albumin administration (1 g/kg for 2 days) to patients with AKI stage 1B or greater. Urinary neutrophil gelatinase-associated lipocalin (NGAL), monomeric NGAL (mNGAL), interleukin-18, and standard biomarkers were measured at diagnosis and on days 3, 7, and 14. Of the 320 cases, 153 were hypovolemia-induced AKI (48%), 93 were HRS-AKI (29%), 39 were ATN (12%), and 35 were due to miscellaneous causes (11%). Among all biomarkers, urinary NGAL measured at day 3 had the greatest accuracy for differential diagnosis between ATN and other types of AKI (area under the receiver operating characteristic curve, 0.87; 95% confidence interval, 0.78-0.95). The cutoff with the best predictive accuracy for ATN diagnosis was 220 µg/g creatinine. Progression of AKI during hospitalization was associated with persistently high NGAL levels, and NGAL was an independent predictive factor of AKI progression. Likewise, NGAL was also an independent predictive factor of 28-day mortality together with Model for End-Stage Liver Disease score. Conclusion: These results support the use of NGAL in clinical practice within the context of a diagnostic algorithm for differential diagnosis of AKI and outcome prediction in cirrhosis. (Hepatology 2019;70:319-333).A cute kidney injury (AKI) is a common complication of patients with advanced cirrhosis hospitalized for an acute decompensation. (1)(2)(3)(4)(5)(6) Importantly, the occurrence of AKI impairs prognosis. The 3-month probability of mortality after AKI is very high, ranging from 28% to 47%. (3)(4)(5)(6)(7)(8) Mortality

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AKI in a Patient with Cirrhosis and Ascites

Cited by 16 publications

References 36 publications

Acute kidney injury in patients with chronic liver disease

Acute kidney injury in patients with chronic liver disease

Difficulties in diagnosing acute kidney injury post liver transplantation using serum creatinine based diagnostic criteria

Neutrophil Gelatinase‐Associated Lipocalin for Assessment of Acute Kidney Injury in Cirrhosis: A Prospective Study

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