Role of Novel Kidney Biomarkers in Patients With Cirrhosis and After Liver Transplantation

Asrani, Sumeet K.; Shankar, Nagasri; Graca, Briget da; Cárdenas, Andrés

doi:10.1002/lt.26344

Cited by 16 publications

(16 citation statements)

References 107 publications

(215 reference statements)

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“…Serum cystatin C, which is released by all nucleated cells and eliminated by glomerular filtration, has been studied extensively for accurate estimation of glomerular filtration rate (GFR). 23 – 27 The combination of cystatin C and sCr was able to calculate GFR more accurately compared to sCr alone, especially when GFR is below 60 ml/min. 28 This should allow for a more accurate representation of a reduction of GFR.…”

Section: Diagnosis Of Hrs-akimentioning

confidence: 99%

Management of hepatorenal syndrome in liver cirrhosis: a recent update

Bera

2022

Therap Adv Gastroenterol

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Hepatorenal syndrome (HRS) is a serious form of renal dysfunction in patients with cirrhosis and ascites. It is an important component of the acute-on-chronic liver failure (ACLF) syndrome. Significant recent changes in the understanding of the pathophysiology of renal dysfunction in cirrhosis include the role of inflammation in addition to hemodynamic changes. The term acute kidney injury (AKI) is now adopted to include all functional and structural forms of acute renal dysfunction in cirrhosis, with various stages describing the severity of the condition. Type 1 hepatorenal syndrome (HRS1) is renamed HRS-AKI, which is stage 2 AKI [doubling of baseline serum creatinine (sCr)] while fulfilling all other criteria of HRS1. Albumin is used for its volume expanding and anti-inflammatory properties to confirm the diagnosis of HRS-AKI. Vasoconstrictors are added to albumin as pharmacotherapy to improve the hemodynamics. Terlipressin, although not yet available in North America, is the most common vasoconstrictor used worldwide. Patients with high grade of ACLF treated with terlipressin are at risk for respiratory failure if there is pretreatment respiratory compromise. Norepinephrine is equally effective as terlipressin in reversing HRS1. Recent data show that norepinephrine may be administered outside the intensive care setting, but close monitoring is still required. There has been no improvement in overall or transplant-free survival shown with vasoconstrictor use, but response to vasoconstrictors with reduction in sCr is associated with improvement in survival. Non-responders to vasoconstrictor plus albumin will need liver transplantation as definite treatment with renal replacement therapy as a bridge therapy. Combined liver and kidney transplantation is recommended for patients with prolonged history of AKI, underlying chronic kidney disease or with hereditary renal conditions. Future developments, such as the use of biomarkers and metabolomics, may help to identify at risk patients with earlier diagnosis to allow for earlier treatment with improved outcomes.

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Section: Diagnosis Of Hrs-akimentioning

confidence: 99%

Management of hepatorenal syndrome in liver cirrhosis: a recent update

Bera

2022

Therap Adv Gastroenterol

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“…Overall, creating a national registry to quantify adverse events and response rates to terlipressin could help advance research in both of these areas. In addition, continued work to identify biomarkers that predict adverse events and responses will be important for optimizing safety and outcomes 36,37 …”

Section: Areas For Future Researchmentioning

confidence: 99%

Respiratory events with terlipressin and albumin in hepatorenal syndrome: A review and clinical guidance

Allegretti

Subramanian

Francoz

et al. 2022

Liver International

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Hepatorenal syndrome (HRS) is a devastating complication of advanced liver disease and is associated with high morbidity and mortality. 1 In this manuscript, we will use the most recent terminology of hepatorenal syndrome-acute kidney injury (HRS-AKI) in reference to the acute onset form of this kidney injury, which replaces the prior term 'HRS type 1' and has a near synonymous definition. 2 HRS-AKI is a form of functional renal failure. The pathophysiological hallmarks include circulatory dysfunction, characterized by splanchnic

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“…There are specific settings that have not been addressed in this review, including ACLF and post-liver transplant kidney outcomes in patients with AKI. These settings have been covered by a recent review 73 .…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Novel Biomarkers of AKI in Cirrhosis

Juanola

Pose

et al. 2022

Semin Liver Dis

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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.

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Role of Novel Kidney Biomarkers in Patients With Cirrhosis and After Liver Transplantation

Cited by 16 publications

References 107 publications

Management of hepatorenal syndrome in liver cirrhosis: a recent update

Management of hepatorenal syndrome in liver cirrhosis: a recent update

Respiratory events with terlipressin and albumin in hepatorenal syndrome: A review and clinical guidance

Novel Biomarkers of AKI in Cirrhosis

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