Advertisement

New diagnostic criteria and management of acute kidney injury

  • Florence Wong
    Correspondence
    Corresponding author. Address: 9EN/222 Toronto General Hospital, 200 Elizabeth Street, Toronto M5G2C4, ON, Canada. Tel.: +1 416 3403834; fax: +1 416 3405019.
    Affiliations
    The Division of Gastroenterology, Department of Medicine, University of Toronto, Canada
    Search for articles by this author
  • Paolo Angeli
    Affiliations
    Unit of Hepatic Emergencies and Liver Transplantation, Department of Medicine – DIMED, University of Padua, Padua, Italy
    Search for articles by this author
Published:October 28, 2016DOI:https://doi.org/10.1016/j.jhep.2016.10.024
      Traditionally, the diagnosis of renal dysfunction in cirrhosis is defined as a 50% increase in serum creatinine (SCr) with a final SCr of ⩾1.5 mg/dl (133 μmol/L) [
      • Salerno F.
      • Gerbes A.
      • Ginès P.
      • Wong F.
      • Arroyo V.
      Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis.
      ]. However, smaller rises in SCr have also been shown to have a negative prognostic impact in decompensated cirrhosis, especially in patients with infection [
      • Wong F.
      • O’Leary J.G.
      • Reddy K.R.
      • Patton H.
      • Kamath P.S.
      • Fallon M.B.
      • et al.
      New consensus definition of acute kidney injury accurately predicts 30-day mortality in patients with cirrhosis and infection.
      ]. Therefore, the International Club of Ascites, in line with other subspecialty communities, formally adapted the term acute kidney injury (AKI) to represent renal dysfunction in cirrhosis [
      • Angeli P.
      • Gines P.
      • Wong F.
      • Bernardi M.
      • Boyer T.D.
      • Gerbes A.
      • et al.
      Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites.
      ]. AKI is now defined as a change in SCr of ⩾0.3 mg/dl (26.5 μmol/L) in ⩽48 h, or a 50% increase in SCr from a baseline that is known or presumed to have occurred in the past 7 days. The baseline SCr was defined as a stable SCr within the previous 3 months. Various alternatives were proposed (Figure) if no such SCr is available. No threshold of SCr was set for the diagnosis of AKI, which would allow for AKI diagnosis at a lower SCr value when the SCr change criteria are met. Various stages of AKI were also defined, depending on the extent of the SCr rise. Thus progression or regression of AKI can be defined as deterioration to a higher stage or improvement to a lower stage respectively (Figure). Type 1 hepatorenal syndrome (HRS-1), the prototype of acute renal dysfunction in cirrhosis, is now re-named as AKI-HRS, defined as ⩾stage 2 AKI while fulfilling all other diagnostic criteria for HRS-1 without referring to a set SCr level.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hepatology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Salerno F.
        • Gerbes A.
        • Ginès P.
        • Wong F.
        • Arroyo V.
        Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis.
        Gut. 2007; 56: 1310-1318
        • Wong F.
        • O’Leary J.G.
        • Reddy K.R.
        • Patton H.
        • Kamath P.S.
        • Fallon M.B.
        • et al.
        New consensus definition of acute kidney injury accurately predicts 30-day mortality in patients with cirrhosis and infection.
        Gastroenterology. 2013; 145: 1280-1288
        • Angeli P.
        • Gines P.
        • Wong F.
        • Bernardi M.
        • Boyer T.D.
        • Gerbes A.
        • et al.
        Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites.
        Gut. 2015; 64: 531-537
        • Trawale J.M.
        • Paradis V.
        • Rautou P.E.
        • Francoz C.
        • Escolano S.
        • Sallee M.
        • et al.
        The spectrum of renal lesions in patients with cirrhosis: a clinicopathological study.
        Liver Int. 2010; 30: 725-732
        • Wong F.
        Diagnosing and treating renal disease in cirrhotic patients.
        Minerva Gastroenterol Dietol. 2016; 62: 253-266
        • Moreau R.
        • Jalan R.
        • Gines P.
        • Pavesi M.
        • Angeli P.
        • Cordoba J.
        • et al.
        Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis.
        Gastroenterology. 2013; 144: 1426-1437
        • Arabi Y.M.
        • Dara S.I.
        • Memish Z.
        • Al Abdulkareem A.
        • Tamim H.M.
        • Al-Shirawi N.
        • et al.
        Antimicrobial therapeutic determinants of outcomes from septic shock among patients with cirrhosis.
        Hepatology. 2012; 56: 2305-2315
        • Chen T.A.
        • Tsao Y.C.
        • Chen A.
        • Lo G.H.
        • Lin C.K.
        • Yu H.C.
        • et al.
        Effect of intravenous albumin on endotoxin removal, cytokines, and nitric oxide production in patients with cirrhosis and spontaneous bacterial peritonitis.
        Scand J Gastroenterol. 2009; 44: 619-625
        • Gerbes A.L.
        Liver cirrhosis and kidney.
        Dig Dis. 2016; 34: 387-390
        • Salerno F.
        • Cazzaniga M.
        • Merli M.
        • Spinzi G.
        • Saibeni S.
        • Salmi A.
        • et al.
        Diagnosis, treatment and survival of patients with hepatorenal syndrome: a survey on daily medical practice.
        J Hepatol. 2011; 55: 1241-1248