Acute kidney injury in liver cirrhosis: new definition and application

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.

Terlipressin Is Superior to Noradrenaline in the Management of Acute Kidney Injury in Acute on Chronic Liver Failure

“…All authors had access to the study data and reviewed and approved the final manuscript. AKI was defined as per the ICA‐AKI criteria . During this period, 340 ACLF patients were screened; 120 who met the ICA‐AKI criteria either at admission or during the course of hospitalization were randomized to either terlipressin or noradrenaline.…”

Collagen type IV remodelling gender‐specifically predicts mortality in decompensated cirrhosis

“…Cirrhosis with portal hypertension can deteriorate with systemic inflammation and acute decompensation (AD). AD of cirrhosis might progress to multiple organ failure, defining acute‐on‐chronic liver failure (ACLF) with poor survival . Interestingly, AD might boost the net deposition of collagen type III, a major component of the interstitial matrix, suggesting a new role of ECM in decompensated cirrhosis …”

“Normal” Creatinine Levels Predict Persistent Kidney Injury and Waitlist Mortality in Outpatients With Cirrhosis

“…Renal dysfunction is a critical determinant of outcomes in patients with cirrhosis . It results from a broad spectrum of pathologies including functional etiologies (transient injury from alterations in perfusion) and structural causes (irreversible damage to the renal parenchyma) . Regardless of the cause, the development of acute kidney injury (AKI) has a profound impact on survival .…”