Novel Biomarkers of AKI in Cirrhosis

Abstract

Acute kidney injury (AKI) is a frequent complication in patients with cirrhosis that is associated with poor outcomes and decreased survival. The definition of AKI in cirrhosis is currently based on changes of serum creatinine levels with respect to baseline values. Differential diagnosis of the causes of AKI is of major relevance, considering that some causes of AKI, such as hepatorenal syndrome, have specific treatment options and different prognosis. Prediction of kidney function recovery and patients’ survival is also crucial in this patient population to guide clinical decisions. AKI biomarkers in cirrhosis have emerged as a promising tool for differential diagnosis and prognosis in this situation. There are consistent data showing that some urine biomarkers, particularly NGAL (neutrophil gelatinase-associated lipocalin), may be useful in daily clinical practice for the differential diagnosis of the cause of AKI in cirrhosis. AKI biomarkers may constitute a useful tool for use in differential diagnosis, prognosis of renal function and survival in patients with cirrhosis. This review focuses on the current state of knowledge and future perspective of novel biomarkers of AKI in cirrhosis.

Acute kidney injury in patients with cirrhosis: Acute Disease Quality Initiative (ADQI) and International Club of Ascites (ICA) joint multidisciplinary consensus meeting

“…Various markers have been assessed in patients with cirrhosis ( Table S2 ). 71 , 133 , 134 Measurement of the fractional excretion of sodium (FENa) to differentiate ATI from HRS-AKI has been thought to be unhelpful since FENa <1% is common in patients with cirrhosis, even in the absence of AKI. 70 , 135 However, if using a lower threshold of FENa of <0.1–0.2% (which may not be possible as many laboratories do not report urine sodium values <20 mEq/L) in combination with other urinary biomarkers and clinical judgement, the test may have improved specificity in identifying HRS-AKI.…”

Acute Kidney Injury in Liver Cirrhosis

“…The ideal biomarker for renal function in cirrhosis should help predict AKI development, define the etiology of AKI, and predict AKI progression and outcomes [25]. Several novel biomarkers have been studied, such as Cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM1), liver fatty acid-binding protein (L-FABP), and IL-18, but their use is still limited.…”