Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine - DIMED, University of Padova, Padova, Italy.
Liver Int. 2017 Jan;37 Suppl 1:116-122. doi: 10.1111/liv.13305.
Patients with advanced liver disease frequently have impaired renal function. Both acute kidney injury (AKI) and chronic kidney disease (CKD) are quite common in patients with cirrhosis and both are associated with a worse prognosis in these patients. A careful assessment of renal function is highly important in these patients to help physicians determine their diagnosis, prognosis and therapeutic management and to define transplantation strategies (liver transplantation alone vs simultaneous liver and kidney transplantation). Although they are still widely used in clinical practice, conventional biomarkers of renal function such as serum creatinine have several limitations in these patients. Recent progress has been made in the evaluation of renal function and new diagnostic criteria for AKI have been proposed. However, certain issues such as the noninvasive assessment of the glomerular filtration rate and/or improvement in the differential diagnosis between hepatorenal syndrome and acute tubular necrosis must still be addressed. The purposes of this paper are: (i) to highlight the importance of the evaluation of renal function in patients with cirrhosis; (ii) to review the state of the art in the assessment of renal function in these patients as well as advances that we expect will be made to improve the accuracy of available tools.
患有晚期肝病的患者常伴有肾功能受损。急性肾损伤 (AKI) 和慢性肾脏病 (CKD) 在肝硬化患者中都很常见，两者均与这些患者的预后较差相关。对这些患者进行肾功能的仔细评估非常重要，以帮助医生确定其诊断、预后和治疗管理，并确定移植策略（单独肝移植与肝肾联合移植）。尽管这些标志物在临床实践中仍被广泛使用，但血清肌酐等传统肾功能标志物在这些患者中存在一些局限性。在肾功能评估方面已经取得了一些进展，并且已经提出了 AKI 的新诊断标准。然而，仍需要解决一些问题，例如肾小球滤过率的非侵入性评估和/或改善肝肾综合征与急性肾小管坏死之间的鉴别诊断。本文的目的是：(i) 强调评估肝硬化患者肾功能的重要性；(ii) 回顾这些患者肾功能评估的最新进展，以及我们期望取得的进展，以提高现有工具的准确性。
