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肝硬化患者的急性肾损伤:从既往到目前的定义与诊断

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

作者信息

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

机构信息

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.

出版信息

Life (Basel). 2025 Aug 6;15(8):1249. doi: 10.3390/life15081249.


DOI:10.3390/life15081249
PMID:40868897
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12387486/
Abstract

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.

摘要

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9508/12387486/0eed6052e2cd/life-15-01249-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9508/12387486/0eed6052e2cd/life-15-01249-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9508/12387486/0eed6052e2cd/life-15-01249-g001.jpg

相似文献

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

Life (Basel). 2025-8-6

[2]
Urine Interleukin 18 and Lipocalin 2 Are Biomarkers of Acute Tubular Necrosis in Patients With Cirrhosis: A Systematic Review and Meta-analysis.

Clin Gastroenterol Hepatol. 2017-7

[3]
Prescription of Controlled Substances: Benefits and Risks

2025-1

[4]
Neutrophil gelatinase-associated lipocalin (NGAL) as biomarker of acute kidney injury: a review of the laboratory characteristics and clinical evidences.

Clin Chem Lab Med. 2012-2-15

[5]
A prospective, multicenter, three-cohort study evaluating contrast-induced acute kidney injury (CI-AKI) in patients with cirrhosis.

J Hepatol. 2024-1

[6]
Effect of albumin treatment duration on response rates and outcomes in patients with cirrhosis and acute kidney injury.

J Hepatol. 2025-9

[7]
Urinary, Plasma, and Serum Biomarkers' Utility for Predicting Acute Kidney Injury Associated With Cardiac Surgery in Adults: A Meta-analysis.

Am J Kidney Dis. 2015-8-5

[8]
Biomarkers for the diagnosis and risk stratification of acute kidney injury: a systematic review.

Kidney Int. 2008-5

[9]
Indoxyl sulfate as a potential tubular function marker across kidney disease models.

Am J Physiol Renal Physiol. 2025-7-1

[10]
Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and meta-analysis.

Am J Kidney Dis. 2009-12

本文引用的文献

[1]
Urine TIMP2.IGFBP7 Reflects Kidney Injury After Moderate Volume Paracentesis in Patients With Ascites: A Randomized Control Study.

JGH Open. 2025-4-22

[2]
The role of urinary biomarkers in the diagnosis of acute kidney injury in patients with liver cirrhosis.

Sci Rep. 2025-4-4

[3]
Renal Complications in Portal Hypertension.

Clin Liver Dis. 2024-8

[4]
Treatment of Acute Kidney Injury: A Review of Current Approaches and Emerging Innovations.

J Clin Med. 2024-4-23

[5]
Moving toward a contemporary classification of drug-induced kidney disease.

Crit Care. 2023-11-9

[6]
The Diagnosis and Non-pharmacological Management of Acute Kidney Injury in Patients with Cirrhosis.

Clin Gastroenterol Hepatol. 2023-9

[7]
Incidence and outcomes of acute kidney injury including hepatorenal syndrome in hospitalized patients with cirrhosis in the US.

J Hepatol. 2023-12

[8]
Renal damage in Hepatorenal Syndrome: A still unsolved issue.

Clin Res Hepatol Gastroenterol. 2023-8

[9]
The Review of Current Knowledge on Neutrophil Gelatinase-Associated Lipocalin (NGAL).

Int J Mol Sci. 2023-6-21

[10]
Hepatorenal Syndrome: Pathophysiology, Diagnosis, and Treatment.

Med Clin North Am. 2023-7

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