Carrier Paul, Debette-Gratien Marilyne, Essig Marie, Loustaud-Ratti Véronique
Hepatology Federation, Hepatology and Gastroenterology Unit, Teaching Hospital Limoges, Tours, Poitiers, Limoges, France.
INSERM U-1248, Medicine and Pharmacy Faculty, Limoges University, Tours, Poitiers, Limoges, France.
Hepatol Res. 2018 Sep;48(10):771-779. doi: 10.1111/hepr.13224. Epub 2018 Aug 10.
In cirrhotic patients, a high serum creatinine value is an independent mortality factor. Similarly, it is predictive of renal insufficiency after liver transplantation. In these cases, chronic kidney disease is also an independent mortality factor. A relevant evaluation of glomerular filtration rate is crucial, particularly in cases of end-stage liver disease or liver transplantation, and is key for the decision to undertake dual liver-kidney transplantation. Serum creatinine or creatinine-based equations are the most used tools in clinical practice but they significantly overestimate renal function. Equilibrium inulin renal clearance remains the gold standard but is time consuming and expensive. Cystatin C and cystatin C-based equations are less influenced by muscle mass or bilirubin value, but their dosage is not standardized and they are expensive. Pharmacological models using exogenous markers, new kidney biomarkers, Doppler coupled with ultrasounds, and kidney histology could be interesting tools but their indications need to be specified.
在肝硬化患者中，血清肌酐值升高是一个独立的死亡因素。同样，它可预测肝移植后的肾功能不全。在这些病例中，慢性肾脏病也是一个独立的死亡因素。对肾小球滤过率进行相关评估至关重要，尤其是在终末期肝病或肝移植病例中，并且是决定是否进行肝肾联合移植的关键。血清肌酐或基于肌酐的公式是临床实践中最常用的工具，但它们会显著高估肾功能。菊粉肾清除率平衡仍是金标准，但耗时且昂贵。胱抑素C和基于胱抑素C的公式受肌肉量或胆红素值的影响较小，但其检测方法未标准化且价格昂贵。使用外源性标志物的药理学模型、新的肾脏生物标志物、多普勒超声以及肾脏组织学可能是有价值的工具，但它们的应用指征需要明确。
