Clin Mol Hepatol.  2016 Dec;22(4):415-422. 10.3350/cmh.2016.0056.

Acute kidney injury in liver cirrhosis: new definition and application

• Wong F

• KMID: 2373144
• DOI: http://doi.org/10.3350/cmh.2016.0056

Abstract

The traditional diagnostic criteria of renal dysfunction in cirrhosis are a 50% increase in serum creatinine (SCr) with a final value above 1.5 mg/dL. This means that patients with milder degrees of renal dysfunction are not being diagnosed, and therefore not offered timely treatment. The International Ascites Club in 2015 adapted the term acute kidney injury (AKI) to represent acute renal dysfunction in cirrhosis, and defined it by an increase in SCr of 0.3 mg/dL (26.4 µmoL/L) in <48 hours, or a 50% increase in SCr from a baseline within ≤3 months. The severity of AKI is described by stages, with stage 1 represented by these minimal changes, while stages 2 and 3 AKI by 2-fold and 3-fold increases in SCr respectively. Hepatorenal syndrome (HRS), renamed AKI-HRS, is defined by stage 2 or 3 AKI that fulfils all other diagnostic criteria of HRS. Various studies in the past few years have indicated that these new diagnostic criteria are valid in the prediction of prognosis for patients with cirrhosis and AKI. The future in AKI diagnosis may include further refinements such as inclusion of biomarkers that can identify susceptibility for AKI, differentiating the various prototypes of AKI, or track its progression.

Keyword

Hepatorenal syndrome; Ascites; Renal dysfunction; Treatment

MeSH Terms

Acute Kidney Injury/complications/*diagnosis/drug therapy/pathology
Biomarkers/blood
Creatinine/blood
Humans
Liver Cirrhosis/*complications
Prognosis
Serum Albumin/therapeutic use
Severity of Illness Index
Biomarkers
Creatinine
Serum Albumin