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Application of the Acute Kidney Injury Network Criteria in Patients with Cirrhosis and Ascites: Benefits and Limitations

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Annual Update in Intensive Care and Emergency Medicine 2015

Part of the book series: Annual Update in Intensive Care and Emergency Medicine 2015 ((AUICEM,volume 2015))

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Abstract

Acute renal failure is a common complication in patients with cirrhosis, occurring in approximately 20% of hospitalized patients [1]. A prompt diagnosis of acute renal failure is a crucial step in the management of these patients and requires a dynamic evaluation of glomerular filtration rate (GFR). Serum creatinine is the most widely used marker of GFR in the general population. Serum creatinine is a powerful prognostic marker in patients with cirrhosis and it has been included in the model for end-stage liver disease (MELD) score which, since the early 2000s, has replaced the Child–Pugh score in the evaluation of prognosis in these patients [2]. Nevertheless, many limitations affect serum creatinine as a marker of acute renal failure. First, the increase in serum creatinine is delayed compared to renal injury and, therefore, it is a late marker of acute renal failure. Second, serum creatinine is also greatly influenced by numerous non-renal factors, such as body weight, race, age, sex. In particular, many biases and pitfalls affect the interpretation of serum creatinine as well as serum creatinine-based formulas in the setting of liver cirrhosis [3]:

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Authors and Affiliations

  1. Department of Medicine (DIMED), University of Padua, Padua, Italy

    P. Angeli, M. Tonon & S. Piano

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  1. P. Angeli
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  2. M. Tonon
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  3. S. Piano
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Correspondence to P. Angeli .

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  1. Université libre de Bruxelles, Dept. of Intensive Care, Erasme Hospital, Brussels, Belgium

    Jean-Louis Vincent Prof.

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Angeli, P., Tonon, M., Piano, S. (2015). Application of the Acute Kidney Injury Network Criteria in Patients with Cirrhosis and Ascites: Benefits and Limitations. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2015. Annual Update in Intensive Care and Emergency Medicine 2015, vol 2015. Springer, Cham. https://doi.org/10.1007/978-3-319-13761-2_29

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  • DOI: https://doi.org/10.1007/978-3-319-13761-2_29

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-13760-5

  • Online ISBN: 978-3-319-13761-2

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