Prognosis of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis: A Prospective Cohort Study
Background/Aims. Acute kidney injury is a common problem for patients with cirrhosis and is associated with poor survival. We aimed to examine the association between type of acute kidney injury and 90-day mortality. Methods. Prospective cohort study at a major US liver transplant center. A nephrolo...
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| Format: | Article |
| Language: | English |
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Wiley
2015-01-01
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| Series: | International Journal of Nephrology |
| Online Access: | http://dx.doi.org/10.1155/2015/108139 |
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| author | Andrew S. Allegretti Guillermo Ortiz Julia Wenger Joseph J. Deferio Joshua Wibecan Sahir Kalim Hector Tamez Raymond T. Chung S. Ananth Karumanchi Ravi I. Thadhani |
| author_facet | Andrew S. Allegretti Guillermo Ortiz Julia Wenger Joseph J. Deferio Joshua Wibecan Sahir Kalim Hector Tamez Raymond T. Chung S. Ananth Karumanchi Ravi I. Thadhani |
| author_sort | Andrew S. Allegretti |
| collection | DOAJ |
| description | Background/Aims. Acute kidney injury is a common problem for patients with cirrhosis and is associated with poor survival. We aimed to examine the association between type of acute kidney injury and 90-day mortality. Methods. Prospective cohort study at a major US liver transplant center. A nephrologist’s review of the urinary sediment was used in conjunction with the 2007 Ascites Club Criteria to stratify acute kidney injury into four groups: prerenal azotemia, hepatorenal syndrome, acute tubular necrosis, or other. Results. 120 participants with cirrhosis and acute kidney injury were analyzed. Ninety-day mortality was 14/40 (35%) with prerenal azotemia, 20/35 (57%) with hepatorenal syndrome, 21/36 (58%) with acute tubular necrosis, and 1/9 (11%) with other (p=0.04 overall). Mortality was the same in hepatorenal syndrome compared to acute tubular necrosis (p=0.99). Mortality was lower in prerenal azotemia compared to hepatorenal syndrome (p=0.05) and acute tubular necrosis (p=0.04). Ten participants (22%) were reclassified from hepatorenal syndrome to acute tubular necrosis because of granular casts on urinary sediment. Conclusions. Hepatorenal syndrome and acute tubular necrosis result in similar 90-day mortality. Review of urinary sediment may add important diagnostic information to this population. Multicenter studies are needed to validate these findings and better guide management. |
| format | Article |
| id | doaj-art-4fdc8510398b4aa5b5c656bad26c4010 |
| institution | OA Journals |
| issn | 2090-214X 2090-2158 |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | International Journal of Nephrology |
| spelling | doaj-art-4fdc8510398b4aa5b5c656bad26c40102025-08-20T02:05:39ZengWileyInternational Journal of Nephrology2090-214X2090-21582015-01-01201510.1155/2015/108139108139Prognosis of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis: A Prospective Cohort StudyAndrew S. Allegretti0Guillermo Ortiz1Julia Wenger2Joseph J. Deferio3Joshua Wibecan4Sahir Kalim5Hector Tamez6Raymond T. Chung7S. Ananth Karumanchi8Ravi I. Thadhani9Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USADivision of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USADivision of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USADivision of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USADivision of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USADivision of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USADivision of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02114, USALiver Center and Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USADivision of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USADivision of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USABackground/Aims. Acute kidney injury is a common problem for patients with cirrhosis and is associated with poor survival. We aimed to examine the association between type of acute kidney injury and 90-day mortality. Methods. Prospective cohort study at a major US liver transplant center. A nephrologist’s review of the urinary sediment was used in conjunction with the 2007 Ascites Club Criteria to stratify acute kidney injury into four groups: prerenal azotemia, hepatorenal syndrome, acute tubular necrosis, or other. Results. 120 participants with cirrhosis and acute kidney injury were analyzed. Ninety-day mortality was 14/40 (35%) with prerenal azotemia, 20/35 (57%) with hepatorenal syndrome, 21/36 (58%) with acute tubular necrosis, and 1/9 (11%) with other (p=0.04 overall). Mortality was the same in hepatorenal syndrome compared to acute tubular necrosis (p=0.99). Mortality was lower in prerenal azotemia compared to hepatorenal syndrome (p=0.05) and acute tubular necrosis (p=0.04). Ten participants (22%) were reclassified from hepatorenal syndrome to acute tubular necrosis because of granular casts on urinary sediment. Conclusions. Hepatorenal syndrome and acute tubular necrosis result in similar 90-day mortality. Review of urinary sediment may add important diagnostic information to this population. Multicenter studies are needed to validate these findings and better guide management.http://dx.doi.org/10.1155/2015/108139 |
| spellingShingle | Andrew S. Allegretti Guillermo Ortiz Julia Wenger Joseph J. Deferio Joshua Wibecan Sahir Kalim Hector Tamez Raymond T. Chung S. Ananth Karumanchi Ravi I. Thadhani Prognosis of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis: A Prospective Cohort Study International Journal of Nephrology |
| title | Prognosis of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis: A Prospective Cohort Study |
| title_full | Prognosis of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis: A Prospective Cohort Study |
| title_fullStr | Prognosis of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis: A Prospective Cohort Study |
| title_full_unstemmed | Prognosis of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis: A Prospective Cohort Study |
| title_short | Prognosis of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis: A Prospective Cohort Study |
| title_sort | prognosis of acute kidney injury and hepatorenal syndrome in patients with cirrhosis a prospective cohort study |
| url | http://dx.doi.org/10.1155/2015/108139 |
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