Departments of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
Clin Mol Hepatol. 2022 Jan;28(1):31-46. doi: 10.3350/cmh.2021.0148. Epub 2021 Aug 2.
Acute kidney injury (AKI) is common in advanced cirrhosis. Prerenal azotemia, hepatorenal syndrome, and acute tubular necrosis are the main causes of AKI in patients with cirrhosis. Evaluation of renal function and differentiation between functional and structural kidney injury are important issues in the management of cirrhosis. However, AKI in cirrhosis exists as a complex clinical spectrum rather than concrete clinical entity. Based on current evidence, changes in serum creatinine (Cr) levels remain the most appropriate standard for defining AKI in cirrhosis. However, serum Cr has a limited role in assessing renal function in this population. This review examines previous studies that investigated the ability of recent biomarkers for AKI in cirrhosis from the perspective of earlier and accurate diagnosis, classification of AKI phenotype, and prediction of clinical outcomes. Serum cystatin C and urine neutrophil gelatinase-associated lipocalin have been extensively studied in cirrhosis, and have facilitated improved diagnosis and prognosis prediction in patients with AKI. In addition, urine N-acetyl-β-D-glucosaminidase, interleukin 18, and kidney injury molecule 1 are other promising biomarkers for advanced cirrhosis. However, the clinical significance of these markers remains unclear because there are no cut-off values defining the normal range and differentiating phenotypes of AKI. In addition, AKI has been defined in terms of serum Cr, and renal biopsy-the gold standard-has not been carried out in most studies. Further discovery of innovate biomarkers and incorporation of various markers could improve the diagnosis and prognosis prediction of AKI, and will translate into meaningful improvements in patient outcomes.
急性肾损伤（AKI）在肝硬化中很常见。肾前性氮质血症、肝肾综合征和急性肾小管坏死是肝硬化患者 AKI 的主要原因。评估肾功能和区分功能性和结构性肾损伤是肝硬化管理中的重要问题。然而，肝硬化中的 AKI 存在于一个复杂的临床谱中，而不是具体的临床实体。基于目前的证据，血清肌酐（Cr）水平的变化仍然是定义肝硬化中 AKI 的最适当标准。然而，在该人群中，血清 Cr 在评估肾功能方面的作用有限。这篇综述从早期和准确诊断、AKI 表型分类以及预测临床结局的角度，考察了先前研究中肝硬化中最近 AKI 生物标志物的能力。血清胱抑素 C 和尿中性粒细胞明胶酶相关脂质运载蛋白在肝硬化中得到了广泛研究，并有助于改善 AKI 患者的诊断和预后预测。此外，尿 N-乙酰-β-D-氨基葡萄糖苷酶、白细胞介素 18 和肾损伤分子 1 也是晚期肝硬化的其他有前途的生物标志物。然而，由于没有定义正常范围和区分 AKI 表型的截止值，这些标志物的临床意义尚不清楚。此外，AKI 是根据血清 Cr 定义的，而大多数研究都没有进行肾活检这一金标准。进一步发现创新的生物标志物并纳入各种标志物可以改善 AKI 的诊断和预后预测，并将转化为患者结局的有意义改善。
