Lungu Andreea, Sarbu Georgiana-Elena, Cotlet Alexandru Sebastian, Savin Ilie-Andreas, Damian Ioana-Roxana, Juncu Simona, Muzica Cristina, Girleanu Irina, Sîngeap Ana-Maria, Stanciu Carol, Trifan Anca, Cojocariu Camelia
Department of Gastroenterology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Universitatii Street No. 16, 700115 Iasi, Romania.
Institute of Gastroenterology and Hepatology, "St. Spiridon" Emergency County Hospital, Bd. Independentei No. 1, 700111 Iasi, Romania.
Life (Basel). 2025 Aug 6;15(8):1249. doi: 10.3390/life15081249.
Acute kidney injury (AKI) is a serious clinical condition that is linked to markedly higher rates of morbidity and mortality in cirrhosis patients. Its diagnosis is challenging due to overlapping clinical and laboratory features among causes such as hepatorenal syndrome (HRS), acute tubular injury (ATI), and prerenal hypovolemia. In order to address the distinct pathophysiology and clinical context of cirrhosis, the definitions and classification of AKI have changed over time, moving from RIFLE and AKIN to KDIGO and ICA-AKI. Because cirrhosis patients have altered muscle mass and fluid retention, traditional markers like serum creatinine (sCr) and urine output have significant limitations. Neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), interleukin-18 (IL-18), and cystatin C (CysC) are some of the new biomarkers that have shown promise in early AKI detection and in differentiating structural from functional kidney injury. NGAL and KIM-1 are sensitive indicators of tubular damage with potential prognostic implications. IL-18 reflects inflammatory injury, and CysC offers a more reliable measure of glomerular filtration. Incorporating these markers may improve early diagnosis, risk stratification, and treatment decisions, representing a key direction for future research in managing AKI in cirrhosis.
急性肾损伤(AKI)是一种严重的临床病症,与肝硬化患者明显更高的发病率和死亡率相关。由于肝肾综合征(HRS)、急性肾小管损伤(ATI)和肾前性血容量不足等病因之间临床和实验室特征重叠,其诊断具有挑战性。为了应对肝硬化独特的病理生理学和临床背景,AKI的定义和分类随时间不断变化,从RIFLE和AKIN发展到KDIGO和ICA - AKI。由于肝硬化患者肌肉量改变和液体潴留,血清肌酐(sCr)和尿量等传统标志物有显著局限性。中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子 - 1(KIM - 1)、白细胞介素 - 18(IL - 18)和胱抑素C(CysC)是一些新的生物标志物,在早期AKI检测以及区分结构性与功能性肾损伤方面显示出前景。NGAL和KIM - 1是肾小管损伤的敏感指标,具有潜在的预后意义。IL - 18反映炎症损伤,CysC能更可靠地衡量肾小球滤过。纳入这些标志物可能改善早期诊断、风险分层和治疗决策,代表了未来肝硬化患者AKI管理研究的关键方向。
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