Clinical utility of urinary neutrophil gelatinase-associated lipocalin and serum cystatin C in a cohort of liver cirrhosis patients with renal dysfunction: a challenge in the diagnosis of hepatorenal syndrome

Gomaa, Salwa H.; Madkour, M. A.

doi:10.1097/meg.0000000000001347

Cited by 14 publications

(15 citation statements)

References 32 publications

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“…33 Both NGAL and CystC are early biomarkers of AKI and are currently widely used clinically. In this study, urine NGAL and serum CystC showed promising performance in predicting AKI and may become useful biomarkers for the occurrence of HRS in patients with liver cirrhosis and ascites, which was consistent with Gomaa et al 34 Remarkably, Previous studies have reported that urine biomarkers were related to the progression and mortality of AKI, especially urinary NGAL, which can discriminate ATN from HRS. 38,39 Another study also demonstrated that urinary NGAL, renal RI, and serum CystC may be useful in the differential diagnosis of AKI and the prognosis of liver cirrhosis.…”

Section: Discussionsupporting

confidence: 91%

Value of shear wave elastography in predicting hepatorenal syndrome in patients with liver cirrhosis and ascites

et al. 2021

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Acute renal impairment is a common complication in patients with liver cirrhosis and is associated with high rates of morbidity and mortality. Patients usually present acute kidney injury (AKI) without renal structural changes. The major causes of AKI include prerenal, intrinsic/parenchymal disorders, obstructive nephropathy and hepatorenal syndrome (HRS). 1-3 Among these, HRS is a special form of renal impairment characterised by rapid progression and poor prognosis. It is reported that HRS has an extremely poor prognosis with 3-month mortality as high as 80%. 4 Therefore, early detection of renal damage in cirrhosis is critical to prevent HRS. There is a lack of methods to evaluate renal function and predict HRS, and the diagnosis mainly depends on exclusion. Serum creatinine, neutrophil gelatinase-associated lipocalin (NGAL), and cystatin C (CystC) are the most common markers used to monitor kidney function, but

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Section: Discussionsupporting

confidence: 91%

Value of shear wave elastography in predicting hepatorenal syndrome in patients with liver cirrhosis and ascites

et al. 2021

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“…Serum cystatin C, which is released by all nucleated cells and eliminated by glomerular filtration, has been studied extensively for accurate estimation of glomerular filtration rate (GFR). 23 – 27 The combination of cystatin C and sCr was able to calculate GFR more accurately compared to sCr alone, especially when GFR is below 60 ml/min. 28 This should allow for a more accurate representation of a reduction of GFR.…”

Section: Diagnosis Of Hrs-akimentioning

confidence: 98%

“…The majority of the HRS-AKI episodes are precipitated by an acute event. It is important to identify all the precipitating events and treat them [23][24][25][26][27] The combination of cystatin C and sCr was able to calculate GFR more accurately compared to sCr alone, especially when GFR is below 60 ml/min. 28 This should allow for a more accurate representation of a reduction of GFR.…”

Section: Pathophysiology Of Aki In Cirrhosismentioning

confidence: 99%

Management of hepatorenal syndrome in liver cirrhosis: a recent update

Bera

2022

Therap Adv Gastroenterol

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Hepatorenal syndrome (HRS) is a serious form of renal dysfunction in patients with cirrhosis and ascites. It is an important component of the acute-on-chronic liver failure (ACLF) syndrome. Significant recent changes in the understanding of the pathophysiology of renal dysfunction in cirrhosis include the role of inflammation in addition to hemodynamic changes. The term acute kidney injury (AKI) is now adopted to include all functional and structural forms of acute renal dysfunction in cirrhosis, with various stages describing the severity of the condition. Type 1 hepatorenal syndrome (HRS1) is renamed HRS-AKI, which is stage 2 AKI [doubling of baseline serum creatinine (sCr)] while fulfilling all other criteria of HRS1. Albumin is used for its volume expanding and anti-inflammatory properties to confirm the diagnosis of HRS-AKI. Vasoconstrictors are added to albumin as pharmacotherapy to improve the hemodynamics. Terlipressin, although not yet available in North America, is the most common vasoconstrictor used worldwide. Patients with high grade of ACLF treated with terlipressin are at risk for respiratory failure if there is pretreatment respiratory compromise. Norepinephrine is equally effective as terlipressin in reversing HRS1. Recent data show that norepinephrine may be administered outside the intensive care setting, but close monitoring is still required. There has been no improvement in overall or transplant-free survival shown with vasoconstrictor use, but response to vasoconstrictors with reduction in sCr is associated with improvement in survival. Non-responders to vasoconstrictor plus albumin will need liver transplantation as definite treatment with renal replacement therapy as a bridge therapy. Combined liver and kidney transplantation is recommended for patients with prolonged history of AKI, underlying chronic kidney disease or with hereditary renal conditions. Future developments, such as the use of biomarkers and metabolomics, may help to identify at risk patients with earlier diagnosis to allow for earlier treatment with improved outcomes.

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“…Serum cystatin C may be a more accurate marker of kidney function in cirrhosis and can be utilized when readily available 11,12 .…”

Section: Interpretation and Applicability Of Ica Diagnostic Criteriamentioning

confidence: 99%

Hepatorenal Syndrome Type 1: From Diagnosis Ascertainment to Goal-Oriented Pharmacologic Therapy

Velez

2022

Kidney360

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Hepatorenal syndrome type 1 (HRS-1) is a serious form of acute kidney injury (AKI) that affects individuals with advanced cirrhosis with ascites. Prompt and accurate diagnosis is essential for effective implementation of therapeutic measures that can favorably alter its clinical course. Despite decades of investigation, HRS-1 continues to be primarily a diagnosis of exclusion. While the diagnostic criteria dictated by the International Club of Ascites (ICA) provide a useful framework to approach the diagnosis of HRS-1, they do not fully reflect the complexity of clinical scenarios that is often encountered in patients with cirrhosis and AKI. Thus, diagnostic uncertainty is often faced. In particular, the distinction between HRS-1 and acute tubular injury (ATI) is challenging with the currently available clinical tools. Because treatment of HRS-1 differs from that of ATI, distinguishing these 2 causes of AKI has direct implications in management. Therefore, the use if the ICA criteria should be enhanced with a more individualized approach and attention to the other phenotypic aspects of HRS-1 and other types of AKI. Liver transplantation is the most effective treatment for HRS-1 but it is only available to a small fraction of the affected patients worldwide. Thus, pharmacological therapy is necessary. Vasoconstrictors aimed to increase mean arterial pressure constitute the most effective approach. Administration of intravenous albumin is an established co-adjuvant therapy. However, the risk for fluid overload in patients with cirrhosis with AKI is not negligible and interventions intended to expand or remove volume should be tailored to the specific needs of the patient. Norepinephrine and terlipressin are the most effective vasoconstrictors and their use should be determined by availability, ease of administration and attention to optimal risk/benefit balance for each clinical scenario.

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Clinical utility of urinary neutrophil gelatinase-associated lipocalin and serum cystatin C in a cohort of liver cirrhosis patients with renal dysfunction: a challenge in the diagnosis of hepatorenal syndrome

Cited by 14 publications

References 32 publications

Value of shear wave elastography in predicting hepatorenal syndrome in patients with liver cirrhosis and ascites

Value of shear wave elastography in predicting hepatorenal syndrome in patients with liver cirrhosis and ascites

Management of hepatorenal syndrome in liver cirrhosis: a recent update

Hepatorenal Syndrome Type 1: From Diagnosis Ascertainment to Goal-Oriented Pharmacologic Therapy

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