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Current knowledge about biomarkers of acute kidney injury in liver cirrhosisCurrent knowledge about biomarkers of acute kidney injury in liver cirrhosis

Other Titles
Current knowledge about biomarkers of acute kidney injury in liver cirrhosis
Authors
Han Ah LeeYeon Seok Seo
Issue Date
Jan-2022
Publisher
대한간학회
Keywords
Acute kidney injury; Liver cirrhosis; Cystatin C; Neutrophil gelatinase-associated lipocalin; N-acetyl-β-Dglucosaminidase
Citation
Clinical and Molecular Hepatology, v.28, no.1, pp.31 - 46
Indexed
SCIE
SCOPUS
KCI
Journal Title
Clinical and Molecular Hepatology
Volume
28
Number
1
Start Page
31
End Page
46
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/55120
DOI
10.3350/cmh.2021.0148
ISSN
2287-2728
Abstract
Acute kidney injury (AKI) is common in advanced cirrhosis. Prerenal azotemia, hepatorenal syndrome, and acute tubular necrosis are the main causes of AKI in patients with cirrhosis. Evaluation of renal function and differentiation between functional and structural kidney injury are important issues in the management of cirrhosis. However, AKI in cirrhosis exists as a complex clinical spectrum rather than concrete clinical entity. Based on current evidence, changes in serum creatinine (Cr) levels remain the most appropriate standard for defining AKI in cirrhosis. However, serum Cr has a limited role in assessing renal function in this population. This review examines previous studies that investigated the ability of recent biomarkers for AKI in cirrhosis from the perspective of earlier and accurate diagnosis, classification of AKI phenotype, and prediction of clinical outcomes. Serum cystatin C and urine neutrophil gelatinase-associated lipocalin have been extensively studied in cirrhosis, and have facilitated improved diagnosis and prognosis prediction in patients with AKI. In addition, urine N-acetyl-β-D-glucosaminidase, interleukin 18, and kidney injury molecule 1 are other promising biomarkers for advanced cirrhosis. However, the clinical significance of these markers remains unclear because there are no cut-off values defining the normal range and differentiating phenotypes of AKI. In addition, AKI has been defined in terms of serum Cr, and renal biopsy—the gold standard—has not been carried out in most studies. Further discovery of innovate biomarkers and incorporation of various markers could improve the diagnosis and prognosis prediction of AKI, and will translate into meaningful improvements in patient outcomes.
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