Acute kidney injury in decompensated cirrhosis

Tsien, Cynthia; Rabie, Rania; Wong, Florence

doi:10.1136/gutjnl-2011-301255

Cited by 209 publications

(188 citation statements)

References 27 publications

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“…Recent data clearly demonstrates even mild renal injury in LC portends a poor prognosis [77], and the stringent HRS or acute kidney injury (AKI) criteria often missed a significant portion of renal injury (Table 1) [78]. Renal dysfunction, the most important independent predictor of death in SBP, has 67% mortality, similar to HRS patients [79].…”

Section: Renalmentioning

confidence: 81%

Perioperative Risk Assessment and Management of Cirrhotic Patients

AL¹,

Dong²,

Nayi³

2015

J Hepatol Gastroint Dis

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Liver cirrhosis is an important risk factor for morbidity and mortality in any type of surgical procedure. For these patients, a distinct and tailored patient optimization approach prior to surgery is required in order to best risk mitigate towards avoiding decompensation and related complications, especially with the chronicity of this disease. This review is to enhance understanding of surgical risks in these patients in selecting patients for elective surgery, or managing those following emergency surgery.

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Section: Renalmentioning

confidence: 81%

Perioperative Risk Assessment and Management of Cirrhotic Patients

AL¹,

Dong²,

Nayi³

2015

J Hepatol Gastroint Dis

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“…The effects were unrelated to serum albumin levels [150]. Minor increases in serum creatinine levels defined as acute kidney injury by the International Club of Ascites adversely affect survival of cirrhotic patients [153,154]. To avoid acute kidney injury and electrolyte disturbances caused by high-dose diuretics, we propose the combined use of tolvaptan and diuretics for ascitic patients (Fig.…”

Section: Cq: Is Albumin Infusion Effective For Treatment Of Cirrhoticmentioning

confidence: 99%

Evidence-based clinical practice guidelines for liver cirrhosis 2015

et al. 2016

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The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for liver cirrhosis in 2015. Eighty-three clinical questions were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. Manual searching of the latest important literature was added until August 2015. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This digest version in English introduces selected clinical questions and statements related to the management of liver cirrhosis and its complications. Branched-chain amino acids relieve hypoalbuminemia and hepatic encephalopathy and improve quality of life. Nucleoside analogues and peginterferon plus ribavirin combination therapy improve the prognosis of patients with hepatitis B virus related liver cirrhosis and hepatitis C related compensated liver cirrhosis, respectively, although the latter therapy may be replaced by direct-acting antivirals. For liver cirrhosis caused by primary biliary cirrhosis and active autoimmune hepatitis, urosodeoxycholic acid and steroid are recommended, respectively. The most adequate modalities for the management of variceal bleeding are the endoscopic injection sclerotherapy for esophageal varices and the balloon-occluded retrograde transvenous obliteration following endoscopic obturation with cyanoacrylate for gastric varices. Beta-blockers are useful for primary prophylaxis of esophageal variceal bleeding. The V 2 receptor antagonist tolvaptan is a useful add-on therapy in careful diuretic therapy for ascites. Albumin infusion is useful for the prevention of paracentesis-induced circulatory disturbance and renal failure. In addition to disaccharides, the nonabsorbable antibiotic rifaximin is useful for the management of encephalopathy. Anticoagulation therapy is proposed for patients with acute-onset or progressive portal vein thrombosis.

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“…1 Importantly, renal impairment is an independent predictor of outcome in myocardial infarction, stroke and peripheral vascular disease. 2 Similarly, it is independently associated with increased morbidity and mortality in acute 3 and chronic 4 liver disease, as well as in liver transplantion, 5 explaining its importance in prognostic stratification.…”

mentioning

confidence: 99%

“…It has been become clear that a state of low-grade chronic inflammation is typically associated with obesity and plays a crucial role in the development of insulin resistance (IR) that, among other factors, may trigger inflammatory and profibrotic cascades culminating in end-stage liver or renal disease. [3][4][5] Insulin resistance is a key metabolic mediator promoting chronic liver and kidney disease, and manipulating insulin sensitivity through insulin sensitizers or lifestyle interventions have been associated with significant improvement in liver and renal functions which denote the important role of IR as a driver of NAFLD and CKD. [6][7][8][9] Given NAFLD severity is strongly linked to CKD, it is not surprising that remissions of NASH or most importantly fibrosis are associated with improvement or stabilization in renal function.…”

mentioning

confidence: 99%

Editorial: treating the liver to treat the kidney in non-alcoholic steatohepatitis

Gifford

Dhaun

2017

Aliment Pharmacol Ther

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a maximum sensitivity and specificity of 93% and 90%, respectively; between IBS and inactive inflammatory bowel disease with a maximum sensitivity and specificity of 89% and 80%, respectively; between IBS and all inflammatory bowel disease patients with a maximum sensitivity of 92% and specificity of 78%; and between IBS and healthy controls with a maximum sensitivity and specificity of 74% and 81% respectively. Following construction of a receiver operating characteristics (ROC) curve, the area under the curve (AUC) for all comparisons ranged between 83.2% for differentiating between IBS and healthy controls and 96.5% for differentiating between IBS and active inflammatory bowel disease.This study highlights the increasing interest in volatile organic compounds for diagnosing and monitoring gastrointestinal diseases.6 This is not the first study to use volatile compounds in differentiating IBS from organic disease and health. A previous case-control study, from the same investigators, used faecal volatile compounds to differentiate IBS-D from inflammatory bowel disease and health 7 and, in a more recent case-control study, a panel of exhaled organic compounds to differentiate IBS from health was derived and validated. 8 Although the findings of this study are encouraging, and perhaps moves us a step closer to a point-of-care test for diagnosing IBS, to date the findings of all these studies have yet to be replicated in large, unselected cohorts of patients presenting with lower gastrointestinal symptoms. Until then, symptom-based diagnostic criteria should remain the recommended method for diagnosing IBS.

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Acute kidney injury in decompensated cirrhosis

Abstract: Minor increases in serum creatinine are clinically relevant and can adversely affect survival. Every effort should be made to avoid precipitation of AKI in cirrhosis and ascites.

Cited by 209 publications

References 27 publications

Perioperative Risk Assessment and Management of Cirrhotic Patients

Perioperative Risk Assessment and Management of Cirrhotic Patients

Evidence-based clinical practice guidelines for liver cirrhosis 2015

Editorial: treating the liver to treat the kidney in non-alcoholic steatohepatitis

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