Urinary Biomarkers of Acute Kidney Injury in Patients with Liver Cirrhosis

Abstract

Acute kidney injury (AKI) is a common complication in cirrhotic patients. Serum creatinine is a poor biomarker for detection of renal impairment in cirrhotic patients. This study aimed to evaluate urinary neutrophil gelatinase-associated lipocalin (NGAL) and urinary interleukin-18 (IL-18) as early biomarkers of acute kidney injury in cirrhotic patients. 160 patients with cirrhosis admitted to the Liver Units at Zagazig University Hospitals were classified into three groups: (I) nonascitic patients, (II) ascitic patients without renal impairment, and (III) ascitic patients with renal impairment. Patients with renal impairment were further divided into four subgroups: [A] prerenal azotemia, [B] chronic kidney disease (CKD), [C] hepatorenal syndrome (HRS), and [D] acute tubular necrosis (ATN). Significant elevation of both urinary NGAL and urinary IL-18 in cirrhotic patients with renal impairment especially in patients with ATN was observed. Urinary NGAL and urinary IL-18 have the ability to differentiate between AKI types in patients with cirrhosis. This could improve risk stratification for patients admitted to the hospital with cirrhosis, perhaps leading to early ICU admission, transplant evaluation, and prompt initiation of HRS therapy and early management of AKI.

Study of Interleukin-18 in Chronic hepatitis C virus related liver diseases

“…There was a highly significant increase in the mean values of serum IL-18 in cirrhotic patients complicated by HCC followed by cirrhotic patients complicated by hepatorenal syndrome (HRS) as shown in Table (4). The significant increase in the mean value of IL-18 in cirrhotic patients complicated by HRS in the present study were in agreement with Qasem et al [19] who reported that IL-18 in HRS patients were higher than those of patients with liver cirrhosis and chronic hepatitis. The authors reported that serum creatinine is a poor biomarker for early detection of renal impairment in cirrhotic patients while IL-18 was early biomarker of acute kidney injury in cirrhotic patients.…”

Whole-blood neutrophil gelatinase-associated lipocalin to predict adverse events in acute kidney injury: A prospective observational cohort study

“…The latter study included many septic patients, who might have had non-kidney-related NGAL elevations associated with critical illness and inflammation, an association supported by other studies [29,30]. Neutrophil gelatinase-associated lipocalin has also been found to be elevated in other forms of organ dysfunction, including acute heart failure [31], hepatorenal syndrome [32,33], severe sepsis, and septic shock [34,35], as well as serving as a marker of increased illness severity [34,36].…”

Urinary Neutrophil Gelatinase Associated Lipocalin as a Biomarker for Diagnosis and Prognosis of Acute Kidney Injury (AKI) in Cirrhotic Patients

“…Many studies reported that this was seen only by electron microscopy [28,36] perhaps resulting from the cellular changes associated with chronic activation of angiotensinaldosterone signaling [37] . It is conceivable that profound renovascular constriction may cause subclinical tubular damage in at least a subset of nephrons [38] .…”