Attieh Rose Mary, Wadei Hani M
Department of Transplant, Division of Kidney and Pancreas Transplant, Mayo Clinic, Jacksonville, FL 32224, USA.
Diagnostics (Basel). 2023 Jul 13;13(14):2361. doi: 10.3390/diagnostics13142361.
Acute kidney injury (AKI) is common in cirrhotic patients affecting almost 20% of these patients. While multiple etiologies can lead to AKI, pre-renal azotemia seems to be the most common cause of AKI. Irrespective of the cause, AKI is associated with worse survival with the poorest outcomes observed in those with hepatorenal syndrome (HRS) and acute tubular necrosis (ATN). In recent years, new definitions, and classifications of AKI in cirrhosis have emerged. More knowledge has also become available regarding the benefits and drawbacks of albumin and terlipressin use in these patients. Diagnostic tools such as urinary biomarkers and point-of-care ultrasound (POCUS) became available and they will be used in the near future to differentiate between different causes of AKI and direct management of AKI in these patients. In this update, we will review these new classifications, treatment recommendations, and diagnostic tools for AKI in cirrhotic patients.
急性肾损伤(AKI)在肝硬化患者中很常见,几乎影响20%的此类患者。虽然多种病因可导致AKI,但肾前性氮质血症似乎是AKI最常见的原因。无论病因如何,AKI都与较差的生存率相关,肝肾综合征(HRS)和急性肾小管坏死(ATN)患者的预后最差。近年来,出现了肝硬化患者AKI的新定义和分类。关于在这些患者中使用白蛋白和特利加压素的利弊,也有了更多的知识。尿生物标志物和床旁超声(POCUS)等诊断工具已可用,并且在不久的将来将用于区分AKI的不同病因并指导这些患者的AKI管理。在本次更新中,我们将回顾肝硬化患者AKI的这些新分类、治疗建议和诊断工具。