Arora Anil, Kumar Ashish, Prasad Narayan, Duseja Ajay, Acharya Subrat K, Agarwal Sanjay K, Aggarwal Rakesh, Anand Anil C, Bhalla Anil K, Choudhary Narendra S, Chawla Yogesh K, Dhiman Radha K, Dixit Vinod K, Gopalakrishnan Natarajan, Gupta Ashwani, Hegde Umapati N, Jasuja Sanjiv, Jha Vivek, Kher Vijay, Kumar Ajay, Madan Kaushal, Maiwall Rakhi, Mathur Rajendra P, Nayak Suman L, Pandey Gaurav, Pandey Rajendra, Puri Pankaj, Rai Ramesh R, Raju Sree B, Rana Devinder S, Rao Padaki N, Rathi Manish, Saraswat Vivek A, Saxena Sanjiv, Sharma Praveen, Singh Shivaram P, Singal Ashwani K, Soin Arvinder S, Taneja Sunil, Varughese Santosh
Institute of Liver, Gastroenterology, & Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110060, Delhi, India.
Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, Uttar Pradesh, India.
J Clin Exp Hepatol. 2021 May-Jun;11(3):354-386. doi: 10.1016/j.jceh.2020.09.005. Epub 2020 Oct 9.
Renal dysfunction is very common among patients with chronic liver disease, and concomitant liver disease can occur among patients with chronic kidney disease. The spectrum of clinical presentation and underlying etiology is wide when concomitant kidney and liver disease occur in the same patient. Management of these patients with dual onslaught is challenging and requires a team approach of hepatologists and nephrologists. No recent guidelines exist on algorithmic approach toward diagnosis and management of these challenging patients. The Indian National Association for Study of Liver (INASL) in association with Indian Society of Nephrology (ISN) endeavored to develop joint guidelines on diagnosis and management of patients who have simultaneous liver and kidney disease. For generating these guidelines, an INASL-ISN Taskforce was constituted, which had members from both the societies. The taskforce first identified contentious issues on various aspects of simultaneous liver and kidney diseases, which were allotted to individual members of the taskforce who reviewed them in detail. A round-table meeting of the Taskforce was held on 20-21 October 2018 at New Delhi to discuss, debate, and finalize the consensus statements. The evidence and recommendations in these guidelines have been graded according to the Grading of Recommendations Assessment Development and Evaluation (GRADE) system with minor modifications. The strength of recommendations (strong and weak) thus reflects the quality (grade) of underlying evidence (I, II, III). We present here the INASL-ISN Joint Position Statements on Management of Patients with Simultaneous Liver and Kidney Disease.
肾功能不全在慢性肝病患者中非常常见，而慢性肾病患者也可能并发肝病。当同一患者同时出现肾脏和肝脏疾病时，临床表现和潜在病因的范围很广。对这些面临双重疾病困扰的患者进行管理具有挑战性，需要肝病专家和肾病专家的团队协作。目前尚无针对这些具有挑战性患者的诊断和管理的算法方法的最新指南。印度国家肝脏研究协会（INASL）与印度肾脏病学会（ISN）共同努力制定关于同时患有肝脏和肾脏疾病患者的诊断和管理的联合指南。为了制定这些指南，成立了一个INASL-ISN特别工作组，其成员来自两个学会。该特别工作组首先确定了关于同时患有肝脏和肾脏疾病各方面的有争议问题，并将其分配给特别工作组的个别成员进行详细审查。特别工作组于2018年10月20日至21日在新德里举行了一次圆桌会议，以讨论、辩论并最终确定共识声明。这些指南中的证据和建议已根据推荐评估、制定和评价分级（GRADE）系统进行了轻微修改后分级。因此，推荐的强度（强和弱）反映了基础证据（I、II、III）的质量（等级）。我们在此展示INASL-ISN关于同时患有肝脏和肾脏疾病患者管理的联合立场声明。
