Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), Spain; Instituto Reina Sofía de Investigación Nefrológica (IRSIN), Spain.
Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), Spain; Instituto Reina Sofía de Investigación Nefrológica (IRSIN), Spain.
J Hepatol. 2015 Sep;63(3):593-600. doi: 10.1016/j.jhep.2015.04.004. Epub 2015 Apr 11.
BACKGROUND & AIMS: Non-steroidal anti-inflammatory drugs (NSAIDs) may cause impairment of kidney function in patients with cirrhosis. Investigational studies demonstrated reversibility of kidney dysfunction after drug withdrawal, but information based on clinical practice is lacking. The aim of the study was to investigate the characteristics and outcome of Acute Kidney Injury (AKI) developing in patients with cirrhosis treated with NSAIDs.
Prospective cohort study in a tertiary referral center of all patients with NSAIDs-associated AKI seen from 2002 to 2014. For comparison, three control groups of patients with hypovolemic-induced AKI, type-1 HRS and ATN, respectively, were also evaluated. Urinary excretion of neutrophil gelatinase-associated lipocalin (uNGAL) was measured in a subset of patients.
Thirty patients with cirrhosis and NSAIDs-associated AKI were identified. In 19 patients (63%) AKI was transient and kidney function rapidly recovered (4±3 days) after NSAIDs withdrawal. In the remaining 11 patients (37%) AKI was more severe and persisted during hospitalization despite drug withdrawal. Patients with persistent AKI had remarkably higher uNGAL levels compared with those of patients with transient AKI (953±1,198 vs. 83±79 μg/g of creatinine, respectively, p=0.008). Moreover, seven of the 11 patients with persistent AKI (64%) died within three months compared with only one of the 19 (5%) patients with transient AKI (p=0.001). Mortality of persistent AKI was similar in NSAIDs patients compared to control groups. The only independent predictive factor of three-month mortality was persistent AKI.
Patients with cirrhosis treated with NSAIDs may develop severe AKI which may be irreversible and associated with poor short-term outcome.
非甾体抗炎药（NSAIDs）可能导致肝硬化患者的肾功能受损。研究表明，停药后肾功能障碍可逆转，但缺乏基于临床实践的信息。本研究旨在调查接受 NSAIDs 治疗的肝硬化患者发生急性肾损伤（AKI）的特征和结局。
对 2002 年至 2014 年期间在一家三级转诊中心接受 NSAIDs 相关 AKI 治疗的所有患者进行前瞻性队列研究。为了进行比较，还评估了三组对照组患者，分别为低血容量性 AKI、1 型肝肾综合征和急性肾小管坏死。在部分患者中测量尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）的排泄。
确定了 30 例肝硬化合并 NSAIDs 相关 AKI 患者。在 19 例（63%）患者中，AKI 是短暂的，并且在 NSAIDs 停药后肾功能迅速恢复（4±3 天）。在其余 11 例（37%）患者中，AKI 更为严重，尽管停药，但在住院期间仍持续存在。与 AKI 短暂的患者相比，持续 AKI 患者的 uNGAL 水平明显更高（分别为 953±1,198μg/g 肌酐和 83±79μg/g 肌酐，p=0.008）。此外，11 例持续 AKI 患者中有 7 例（64%）在 3 个月内死亡，而 19 例 AKI 短暂的患者中仅有 1 例（5%）死亡（p=0.001）。持续 AKI 的死亡率在 NSAIDs 患者与对照组之间相似。三个月死亡率的唯一独立预测因素是持续 AKI。
接受 NSAIDs 治疗的肝硬化患者可能会发生严重的 AKI，且可能是不可逆的，并伴有不良的短期预后。
