Sequential changes in urinary biomarker levels in patients with cirrhosis and severe hepatorenal syndrome.
Cristina SoléAnn T MaElsa SolaMarta CarolNúria FabrellasAdrià JuanolaLaura NapoleoneJordi Gratacós-GinèsOctavi BassegodaMarta CerveraMartina PérezAna Belén RubioEmma AvitabileManuel Morales-RuizIsabel GrauperaElisa PosePatrick S KamathPere GinèsPublished in: Liver international : official journal of the International Association for the Study of the Liver (2021)
Whether tubular injury develops in patients with acute kidney injury owing to hepatorenal syndrome (AKI-HRS) is controversial. We performed repeated measurements of biomarkers of tubular injury during a 14-day period in 60 patients with cirrhosis and AKI (34 with AKI-HRS meeting the classical definition of type 1 HRS and 26 with AKI owing to acute tubular necrosis, AKI-ATN). Nineteen of 34 patients had resolution of AKI-HRS, while the remainder had persistent AKI-HRS. The persistence of AKI-HRS was associated with remarkably high short-term mortality. There were no significant differences in urinary NGAL or IL-18 between patients with resolution vs those with persistent AKI-HRS throughout the 14-day period. By contrast, biomarker levels were significantly lower in AKI-HRS, even if persistent, compared to AKI-ATN. These findings are highly suggestive of lack of significant tubular injury in AKI-HRS and could be of value in the clinical decision between combined liver-kidney or liver transplantation alone in patients with cirrhosis and AKI candidates to transplantation.
Keyphrases
- acute kidney injury
- cardiac surgery
- stem cells
- type diabetes
- magnetic resonance imaging
- newly diagnosed
- end stage renal disease
- ejection fraction
- magnetic resonance
- chronic kidney disease
- endothelial cells
- intensive care unit
- risk factors
- cardiovascular events
- liver failure
- high glucose
- decision making
- peritoneal dialysis
- extracorporeal membrane oxygenation