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The role of urinary biomarkers in the diagnosis of acute kidney injury in patients with liver cirrhosis.

作者信息

Altran Willian Sacco, de Sousa Luiz Felipe, Dos Santos Cortinhas Renan, Ponce Daniela

机构信息

Internal Medicine Department, Botucatu School of Medicine, University of Sao Paulo State, UNESP, Avenue Mario Rubens Montenegro without number, Botucatu, SP, 18618-687, Brazil.

出版信息

Sci Rep. 2025 Apr 4;15(1):11575. doi: 10.1038/s41598-025-93935-0.


DOI:10.1038/s41598-025-93935-0
PMID:40185864
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11971331/
Abstract

AKI is common in patients with liver cirrhosis (LC) affecting (30 to 50%). Our study aimed to evaluate the role of urinary biomarkers as predictors of AKI, its etiology and mortality. We performed a prospective cohort study of patients with LC during 1 year. Urine samples for biomarkers dosage were collected within 48 h of hospital admission. Diagnosis of AKI was performed according to KDIGO 2012 criteria. The results were presented using Chi-square, T test, AUC-ROC and logistic regression (p < 0.05). We included 100 patients, 58.5 ± 16.1 years, main etiologies of LC were alcohol and and metabolic disfunction associated with steatohepatitis. Infection was the main cause of LC decompensation. AKI occurred in 53% of patients and mortality was 20%. CHILD C, infectious as cause of decompensation, baseline creatinine, need for mechanical ventilation and noradrenaline use and urinary were associated with AKI. We found no association between AKI and KIM-1 and IL-18. The main etiologies of AKI were transient ischeamia (49%), renal (43.4%), and hepatorenal syndrome (HRS) (7.5%). There was difference between the groups in hematuria, proteinuria, FENa, FEUr and uNGAL which were higher in renal AKI when compared to transient ischaemia and HSR. FENa and FEUr were excellent predictors of AKI etiology (AUC-ROC > 0.80, sensitivity and specificity > 0.80), while only uNGAL was good predictor of AKI etiology (AUC-ROC, sensitivity and specificity > 0.70). Regarding death, CHILD C, baseline creatinine, KDIGO 3, septic AKI, need for mechanical ventilation and IL-18 were identified as associated variables. Only NGAL was predictor of AKI and its etiology, anticipating AKI diagnosis in 2.5 ± 1.1 days, while IL-18 was predictor of death. We highlight the importance of lower-cost biochemical tests as FENa and FEUr and clinical information as CHILD and cause of LC descompensation which were relevant in predicting AKI, its etiology and death.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50bb/11971331/690cbc7dd780/41598_2025_93935_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50bb/11971331/b9665a956d68/41598_2025_93935_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50bb/11971331/13ea0f5ad55f/41598_2025_93935_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50bb/11971331/fb0fd4198bc0/41598_2025_93935_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50bb/11971331/039db0d5685c/41598_2025_93935_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50bb/11971331/690cbc7dd780/41598_2025_93935_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50bb/11971331/b9665a956d68/41598_2025_93935_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50bb/11971331/13ea0f5ad55f/41598_2025_93935_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50bb/11971331/fb0fd4198bc0/41598_2025_93935_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50bb/11971331/039db0d5685c/41598_2025_93935_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50bb/11971331/690cbc7dd780/41598_2025_93935_Fig5_HTML.jpg

相似文献

[1]
The role of urinary biomarkers in the diagnosis of acute kidney injury in patients with liver cirrhosis.

Sci Rep. 2025-4-4

[2]
Urinary biomarkers and progression of AKI in patients with cirrhosis.

Clin J Am Soc Nephrol. 2014-11-7

[3]
Kidney biomarkers and differential diagnosis of patients with cirrhosis and acute kidney injury.

Hepatology. 2014-6-26

[4]
Urinary neutrophil gelatinase-associated lipocalin predicts kidney outcome and death in patients with cirrhosis and bacterial infections.

J Hepatol. 2014-3-5

[5]
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BMC Nephrol. 2015-8-18

[6]
Urinary calprotectin, kidney injury molecule-1, and neutrophil gelatinase-associated lipocalin for the prediction of adverse outcome in pediatric acute kidney injury.

Eur J Pediatr. 2017-6

[7]
Prediction of contrast-induced acute kidney injury by early post-procedural analysis of urinary biomarkers and intra-renal Doppler flow indices in patients undergoing coronary angiography.

J Interv Cardiol. 2017-10

[8]
Biomarkers for acute kidney injury in decompensated cirrhosis: A prospective study.

Nephrology (Carlton). 2019-2

[9]
Urinary Biomarkers at the Time of AKI Diagnosis as Predictors of Progression of AKI among Patients with Acute Cardiorenal Syndrome.

Clin J Am Soc Nephrol. 2016-9-7

[10]
Urine neutrophil gelatinase-associated lipocalin: a diagnostic and prognostic marker for acute kidney injury (AKI) in hospitalized cirrhotic patients with AKI-prone conditions.

BMC Gastroenterol. 2015-10-16

引用本文的文献

[1]
Acute Kidney Injury in Patients with Liver Cirrhosis: From Past to Present Definition and Diagnosis.

Life (Basel). 2025-8-6

本文引用的文献

[1]
Acute kidney injury in patients with cirrhosis: Acute Disease Quality Initiative (ADQI) and International Club of Ascites (ICA) joint multidisciplinary consensus meeting.

J Hepatol. 2024-7

[2]
Incidence and outcomes of acute kidney injury including hepatorenal syndrome in hospitalized patients with cirrhosis in the US.

J Hepatol. 2023-12

[3]
Acute Kidney Injury in Liver Cirrhosis.

Diagnostics (Basel). 2023-7-13

[4]
The prognostic impact of acute kidney injury recovery patterns in critically ill patients with cirrhosis.

Liver Transpl. 2023-3-1

[5]
Novel Biomarkers of AKI in Cirrhosis.

Semin Liver Dis. 2022-11

[6]
Diagnostic and prognostic performance of urinary neutrophil gelatinase-associated lipocalin in patients with cirrhosis and acute kidney injury.

Hepatology. 2023-5-1

[7]
Acute kidney disease is common and associated with poor outcomes in patients with cirrhosis and acute kidney injury.

J Hepatol. 2022-7

[8]
Role of Novel Kidney Biomarkers in Patients With Cirrhosis and After Liver Transplantation.

Liver Transpl. 2022-3

[9]
Acute kidney injury in hospitalized cirrhotic patients: Risk factors, type of kidney injury, and survival.

JGH Open. 2020-12-14

[10]
Incidence, Mortality and Predictors of Acute Kidney Injury in Patients with Cirrhosis: A Systematic Review and Meta-analysis.

J Clin Transl Hepatol. 2020-6-28

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