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 30 June 2016

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Predicting the development of acute kidney injury in liver cirrhosis

This month's Alimentary Pharmacology & Therapeutics evaluates glomerular filtration rate, proteinuria and kidney injury biomarkers in patients iwth liver cirrohsis.

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The timely diagnosis of acute kidney injury (AKI) in liver cirrhosis is challenging.
 
Professor Wendon and colleagues from the United Kingdom evaluate whether quantification of glomerular filtration rate (GFR), proteinuria and kidney injury biomarkers can accurately predict the development of acute kidney injury.
 
The team performed a prospective cohort analysis of patients with cirrhosis.

Measures of baseline kidney function included serum creatinine, iohexol clearance and urine protein:creatinine ratio.

Blood and urine samples were collected daily.

Acute kidney injury was strongly predicted by urine protein:creatinine ratio above the cut-off
Alimentary Pharmacology & Therapeutics

A retrospective analysis of cystatin C GFR and neutrophil gelatinase-associated lipocalin (NGAL) measured 48 hours prior to the diagnosis of acute kidney injury was undertaken to evaluate their ability to predict the development of acute kidney injury.
 
The team observed that 18 of the 34 cirrhosis patients studied developed acute kidney injury.

A GFR less 60 mL/min/1.73 m2 was identified in 56% with Iohexol clearance compared to 8% using the 4-variable modified diet in renal disease formula.

Prediction of acute kidney injury, 48 hours prior to the development of acute kidney injury with cystatin C GFR and serum NGAL concentration were similar.

The researchers found that the development of acute kidney injury was strongly predicted by urine protein:creatinine ratio above the cut-off of more than 30.
 
Professor Wendon's team commented, "In patients with liver cirrhosis a urine protein:creatinine ratio of more than 30 predicts acute kidney injury."

"Iohexol clearance and cystatin C formulae identify a greater proportion of patients with a GFR less than 60 mL/min/1.73 m2, which also predicts the development of acute kidney injury."

Aliment Pharmacol Ther 2013: 37(10): 989-997
14 May 2013

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