Acute kidney injury in patients with cirrhosis: Acute Disease Quality Initiative (ADQI) and International Club of Ascites (ICA) joint multidisciplinary consensus meeting

Seeing and Sensing the Hepatorenal Syndrome (HRS): The Growing Role of Ultrasound-Based Techniques as Non-Invasive Tools for the Diagnosis of HRS

“…However, adverse events related to Terlipressin may occur, even when using this route; in this case, its administration should be discontinued. Other situations in which the early discontinuation of Terlipressin is recommended, according to the most recent consensus on HRS issued by the Acute Disease Quality Initiative (ADQI) and International Club of Ascites (ICA), are: (a) SCr returns within 0.3 mg/dL of baseline, (b) kidney function does not improve after 48 h on maximum tolerated doses, and (c) RRT is indicated [10].…”

“…In order to accelerate the differential diagnosis process between prerenal AKI and the other types of AKI, according to the algorithm, the withdrawal of diuretics and other nephrotoxic drugs should be implemented and an ultrasonography to exclude an obstructive AKI should be performed, as should the plasma volume expansion, for at least 48 h, as specified in Table 2 [7]. According to the latest ADQI and IAC joint consensus, plasma expansion with albumin alone (1 g per kg bodyweight per day) is not recommended anymore for this purpose, except where it is specifically indicated [10]. It must be emphasized that the diagnosis of HRS remains an exclusionary one in patients with decompensated advanced liver disease and AKI.…”

Notfallmedizinisch relevante Komplikationen der Leberzirrhose

“…▶Tab. 2 Graduierung der akuten Nierenschädigung nach den Vorgaben des ICA, adaptiert nach [5,48]. Cave Patienten sind unter dieser Behandlung hinsichtlich einer kardialen Volumenüberladung (durch die Volumenexpansion), möglichen kardiovaskulären und respiratorischen Beschwerden (durch die vasokonstriktive Therapie) sowie infektassoziierten Komplikationen zu überwachen, die bei über 40 % aller Patienten auftreten können [50].…”

“…Vorgehen bei Vorliegen einer AKI bei Leberzirrhose und differenzialdiagnostische Abklärung eines möglichen AKI-HRS[5,48]. AKI-HRS = akute Nierenschädigung-hepatorenales Syndrom; NSAID = nicht steroidale Antiphlogistika ▶Tab.…”

KRT in Patients with AKI and Cirrhosis

“…3 Initiation of KRT in patients with cirrhosis should be individualized and requires consideration of the overall trajectory of the patient's clinical status, including both kidney and liver health (e.g., AKI stage, underlying CKD, model of end-stage liver disease score), trend in laboratory values, and anticipated or observed AKI-related complications. 3,4 The decision as to when a patient reaches any of these clinical parameters is a matter of clinical judgment.…”