Diagnosis and treatment of acute kidney injury in patients with cirrhosis
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摘要: 急性肾损伤(AKI)是肝硬化患者的一种常见并发症,以肾小球滤过率突然下降,代谢废物潴留、水电解质失调、酸碱平衡紊乱为特点。AKI显著增加肝硬化患者病死率。其早期诊断和治疗对降低病死率、改善预后至关重要。简述了AKI诊断标准的演进,肾功能损伤新型标志物如胱抑素C、肾损伤分子1、中性粒细胞明胶酶相关性脂质运载蛋白的应用情况以及肝硬化AKI的治疗手段。尽管血肌酐和尿量有诸多缺点,但仍是AKI诊断的主要标准。寻找具有临床应用价值的新型标志物将成为研究的热点,未来仍须在肝硬化AKI的基础和临床方面努力专研,以寻求新的突破。Abstract: Acute kidney injury is a common complication in patients with cirrhosis. It is characterized by a sudden drop in glomerular filtration rate, retention of metabolic waste products, water-electrolyte imbalance, and acid-base disturbance. It markedly increases mortality in cirrhotic patients. Therefore, early diagnosis and treatment of acute kidney injury are essential to reduce mortality and improve prognosis.The development of the diagnostic criteria for acute kidney injury, the clinical application of new biomarkers of renal function such as cystatin C, kidney injury molecule-1, and neutrophil gelatinase-associated lipocalin, and the management of acute kidney injury in cirrhotic patients are reviewed. Although creatinine test and monitoring of urinary output have their disadvantages, they remain the main diagnostic criteria for acute kidney injury. Development of new biomarkers for clinical use and elucidation of the underlying mechanisms of acute kidney injury have become a hotspot of basic and clinical research.
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Key words:
- liver cirrhosis /
- acute kidney injury /
- hepatorenal syndrome /
- diagnosis /
- review
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[1]GARCIA-TSAO G, PARIKH CR, VIOLA A.Acute kidney Injury in cirrhosis[J].Hepatology, 2008, 48 (6) :2064-2077. [2]WONG F, O'LEARY JG, REDDY KR, et al.New consensus definition of acute kidney injury accurately predicts 30-day mortality in patients with cirrhosis and infection[J].Gastroenterology, 2013, 145 (6) :1280-1288. [3]KDIGO Disease:Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group.KDIGO clinacal practice guideline for acute kidney injury[J].Kidney Inter, 2012, 2:1-138. [4]MUCIO-BERMEJO J, CARRILLO-ESPER R, URIBE M, et al.Acute kidney injury in critically ill cirrhotic patients:a review[J].Ann Hepatol, 2012, 11 (3) :301-310. [5]GINS A, ESCORSELL A, GINS P, et al.Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites[J].Gastroenterology, 1993, 105 (1) :229-236. [6]ARROYO V, GINS P, GERBES AL, et al.Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis.International Ascites Club[J].Hepatology, 1996, 23 (1) :164-176. [7]SALERNO F, GERBES A, GINS P, et al.Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis[J].Gut, 2007, 56 (9) :1310-1318. [8]NADIM MK, KELLUM JA, DAVENPORT A, et al.Hepatorenal syndrome:the 8th international consensus conference of the Acute Dialysis Quality Initiative (ADQI) Group[J].Crit Care, 2012, 16 (1) :r23. [9]BELCHER JM, PARIKH CR, GARCIA-TSAO G, et al.Acute kidney injury in patients with cirrhosis:perils and promise[J].Clin Gastroenterol Hepatol, 2013, 11 (12) :1550-1558. [10]BELLOMO R, RONCO C, KELLUM JA, et al.Acute renal failuredefinition, outcome measures, animal models, fluid therapy and information technology needs:the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group[J].Crit Care, 2004, 8 (4) :204-212. [11] MEHTA RL, KELLUM JA, SHAH SV, et al.Acute kidney injury network:report of an initiative to improve outcomes in acute kidney injury[J].Crit Care, 2007, 11 (2) :r31. [12]PALEVSKY PM, LIU KD, BROPHY PD, et al.KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury[J].Am J Kidney Dis, 2013, 61 (5) :649-672. [13]ANGELI P, SANYAL A, MOLLER S, et al.Current limits and future challenges in the management of renal dysfunction in patients with cirrhosis:report from the International Club of Ascites[J].Liver Int, 2013, 33 (1) :16-23. [14]FAGUNDES C, BARRETO R, GUEVARA M, et al.A modified acute kidney injury classification for diagnosis and risk stratification of impairment of kidney function in cirrhosis[J].J Hepatol, 2013, 59 (3) :474-481. [15]KNAPP ML, HADID O.Investigations into negative interference by jaundiced plasma in kinetic Jaffémethods for plasma creatinine determination[J].Ann Clin Biochem, 1987, 24 (Pt 1) :85-97. [16]FRANCOZ C, PRID, ABDELRAZEK W, et al.Inaccuracies of creatinine and creatinine-based equations in candidates for liver transplantation with low creatinine:impact on the model for endstage liver disease score[J].Liver Transpl, 2010, 16 (10) :1169-1177. [17]TSIGOU E, PSALLIDA V, DEMPONERAS C, et al.Role of new biomarkers:functional and structural damage[J].Crit Care Res Pract, 2013, 2013:361078. [18]CHUNG M, JUN D, SUNG S.Diagnostic value of cystatin C for predicting acute kidney injury in patients with liver cirrhosis[J].Korean J Hepatol, 2010, 16 (3) :301-307. [19]ICHIMURA T, BONVENTRE JV, BAILLY V, et al.Kidney injury molecule-1 (KIM-1) , a putative epithelial cell adhesion molecule containing a novel immunoglobulin domain, is up-regulated in renal cells after injury[J].J Biol Chem, 1998, 273 (7) :4135-4142. [20]BARRETO R, FAGUNDES C, MOREIRA R, et al.Urinary kidney injury molecule-1 (Kim-1) in the assessment of acute kidney injury in patients with cirrhosis[J].J Hepatol, 2013, 58 (3) :419. [21]COWLAND JB, BORREGAARD N.Molecular characterization and pattern of tissue expression of the gene for neutrophil gelatinase-associated lipocalin from humans[J].Genomics, 1997, 45 (1) :17-23. [22]VERNA EC, BROWN RS, FARRAND E, et al.Urinary neutrophil gelatinase-associated lipocalin predicts mortality and identifies acute kidney injury in cirrhosis[J].Dig Dis Sci, 2012, 57 (9) :2362-2370. [23]CRUZ DN, BAGSHAW SM, MAISEL A, et al.Use of biomarkers to assess prognosis and guide management of patients with acute kidney injury[J].Contrib Nephrol, 2013, 182:45-64. [24]MCCULLOUGH PA, SHAW AD, HAASE M, et al.Diagnosis of acute kidney injury using functional and injury biomarkers:workgroup statements from the tenth Acute Dialysis Quality Initiative Consensus Conference[J].Contrib Nephrol, 2013, 182:13-29. [25] European Association for the Study of the Liver.EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis[J].J Hepatol, 2010, 53 (3) :397-417. [26]GHOSH S, CHOUDHARY NS, SHARMA AK, et al.Noradrenaline vs terlipressin in the treatment of type 2 hepatorenal syndrome:a randomized pilot study[J].Liver Int, 2013, 33 (8) :1187-1193. [27]DAVENPORT A, WILL EJ, DAVISON AM, et al.Effect of renal replacement therapy on patients with combined acute renal and fulminant hepatic failure[J].Kidney Int Suppl, 1993, 41:s245-s251. [28]WONG F, RAINA N, RICHARDSON R.Molecular adsorbent recirculating system is ineffective in the management of type 1 hepatorenal syndrome in patients with cirrhosis with ascites who have failed vasoconstrictor treatment[J].Gut, 2010, 59 (3) :381-386. [29]ANDERSON CL, SAAD WE, KALAGHER SD, et al.Effect of transjugular intrahepatic portosystemic shunt placement on renal function:a 7-year, single-center experience[J].J Vasc Interv Radiol, 2010, 21 (9) :1370-1376. [30]RUIZ R, KUNITAKE H, WILKINSON AH, et al.Long-term analysis of combined liver and kidney transplantation at a single center[J].Arch Surg, 2006, 141 (8) :735-741. [31]CAMPBELL MS, KOTLYAR DS, BRENSINGER CM, et al.Renal function after orthotopic liver transplantation is predicted by duration of pretransplantation creatinine elevation[J].Liver Transpl, 2005, 11 (9) :1048-1055. [32]EASON JD, GONWA TA, DAVIS CL, et al.Proceedings of consensus conference on simultaneous liver kidney transplantation (SLK) [J].Am J Transplant, 2008, 8 (11) :2243-2251.
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