Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Liver Int. 2021 Nov;41(11):2729-2732. doi: 10.1111/liv.15069. Epub 2021 Oct 5.
Whether tubular injury develops in patients with acute kidney injury owing to hepatorenal syndrome (AKI-HRS) is controversial. We performed repeated measurements of biomarkers of tubular injury during a 14-day period in 60 patients with cirrhosis and AKI (34 with AKI-HRS meeting the classical definition of type 1 HRS and 26 with AKI owing to acute tubular necrosis, AKI-ATN). Nineteen of 34 patients had resolution of AKI-HRS, while the remainder had persistent AKI-HRS. The persistence of AKI-HRS was associated with remarkably high short-term mortality. There were no significant differences in urinary NGAL or IL-18 between patients with resolution vs those with persistent AKI-HRS throughout the 14-day period. By contrast, biomarker levels were significantly lower in AKI-HRS, even if persistent, compared to AKI-ATN. These findings are highly suggestive of lack of significant tubular injury in AKI-HRS and could be of value in the clinical decision between combined liver-kidney or liver transplantation alone in patients with cirrhosis and AKI candidates to transplantation.
由于肝肾综合征（AKI-HRS），急性肾损伤患者是否会出现管状损伤存在争议。我们对 60 例肝硬化合并 AKI 患者（34 例 AKI-HRS 符合 1 型 HRS 的经典定义，26 例 AKI 归因于急性肾小管坏死，AKI-ATN）进行了为期 14 天的重复管状损伤生物标志物测量。34 例患者中有 19 例 AKI-HRS 得到缓解，其余患者持续存在 AKI-HRS。持续存在 AKI-HRS 与极高的短期死亡率显著相关。在整个 14 天期间，缓解 AKI-HRS 与持续 AKI-HRS 患者的尿 NGAL 或 IL-18 之间没有显著差异。相比之下，即使持续存在，AKI-HRS 的生物标志物水平也明显低于 AKI-ATN。这些发现高度提示 AKI-HRS 中不存在明显的管状损伤，这对于肝硬化合并 AKI 患者是否进行联合肝肾移植或单独肝移植的临床决策可能具有重要价值。
