Acute Kidney Injury and Hepatorenal Syndrome

Moon Young Kim; Yeon Seok Seo

doi:10.4166/kjg.2018.72.2.64

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Kim and Seo: Acute Kidney Injury and Hepatorenal Syndrome

Special Review

Recent Update in the Management for the Complicatins of Portal Hypertension in Liver Cirrhosis

The Korean Journal of Gastroenterology 2018; 72(2): 64-73.

Published online: 23 August 2018

DOI: https://doi.org/10.4166/kjg.2018.72.2.64

Acute Kidney Injury and Hepatorenal Syndrome

Moon Young Kim, Yeon Seok Seo¹

Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.

¹Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.

Correspondence to: Yeon Seok Seo, Department of Internal Medicine, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea. Tel: +82-2-920-6608, Fax: +82-2-953-1943, drseo@korea.ac.kr

Received 12 July 2018 Revised 26 July 2018 Accepted 28 July 2018

Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Acute kidney injury (AKI) is common in patients with liver cirrhosis, occurring in 13-20% of patients hospitalized with decompensated cirrhosis, and is significantly associated with the prognosis. The development and progression of AKI is an independent predictive factor for mortality in these patients. If AKI develops, the renal function declines progressively even if AKI is improved later, the patients have a poorer prognosis compared to those who have not developed AKI. In addition, in patients without appropriate treatment or no improvement with the initial treatment, AKI often progress to hepatorenal syndrome (HRS), which is associated with significant morbidity and mortality. Therefore, early detection and appropriate management for the development of AKI is very important in these patients. Recently, there have been significant revisions in the diagnostic criteria and treatment of AKI and HRS; this manuscript reviews these changes.

Keywords: Liver cirrhosis, Hypertension portal, Acute kidney injury, Hepatorenal syndrome

Figures and Tables

Table 1

Serum Creatinine Level for the Diagnosis of Acute Kidney Injury in the RIFLE, AKIN, KDIGO, and ICA-AKI Criterie

RIFLE, Risk, Injury, Failure, Loss of renal function, and End-stage renal disease; AKIN, Acute Kidney Injury Network; KDIGO, Kidney Disease Improving Global Outcome; ICA-AKI, international club of ascites-acute kidney injury; sCr, serum creatinine.

Table 2

Diagnostic Criteria of HRS of the International Club of Ascites in 199621

HRS, hepatorenal syndrome.

Table 3

Diagnostic Criteria of HRS of the International Club of Ascites in 20077

HRS, hepatorenal syndrome.

Table 4

Diagnostic Criteria of Hepatorenal Syndrome by the International Club of Ascites in 201526

ICA-AKI, international club of ascites-acute kidney injury; NSAIDs, nonsteroidal anti-inflammatory drugs; RBCs, red blood cells.

Table 5

Definitions of Treatment Response26

AKI, acute kidney injury; RRT, renal replacement therapy; sCr, serum creatinine.

Notes

^{Financial support} None.

^{Conflict of interest} None.

References

1. Garcia-Tsao G, Parikh CR, Viola A. Acute kidney injury in cirrhosis. Hepatology. 2008; 48:2064–2077.

2. Cárdenas A, Ginès P, Uriz J, et al. Renal failure after upper gastrointestinal bleeding in cirrhosis: incidence, clinical course, predictive factors, and short-term prognosis. Hepatology. 2001; 34:671–676.

3. Tandon P, Garcia-Tsao G. Renal dysfunction is the most important independent predictor of mortality in cirrhotic patients with spontaneous bacterial peritonitis. Clin Gastroenterol Hepatol. 2011; 9:260–265.

4. Belcher JM, Garcia-Tsao G, Sanyal AJ, et al. Association of AKI with mortality and complications in hospitalized patients with cirrhosis. Hepatology. 2013; 57:753–762.

5. Bucsics T, Mandorfer M, Schwabl P, et al. Impact of acute kidney injury on prognosis of patients with liver cirrhosis and ascites: a retrospective cohort study. J Gastroenterol Hepatol. 2015; 30:1657–1665.

6. Tsien CD, Rabie R, Wong F. Acute kidney injury in decompensated cirrhosis. Gut. 2013; 62:131–137.

7. Salerno F, Gerbes A, Ginès P, Wong F, Arroyo V. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Gut. 2007; 56:1310–1318.

8. Tan HK, Marquez M, Wong F, Renner EL. Pretransplant type 2 hepatorenal syndrome is associated with persistently impaired renal function after liver transplantation. Transplantation. 2015; 99:1441–1446.

9. Gonwa TA, Klintmalm GB, Levy M, Jennings LS, Goldstein RM, Husberg BS. Impact of pretransplant renal function on survival after liver transplantation. Transplantation. 1995; 59:361–365.

10. Warner NS, Cuthbert JA, Bhore R, Rockey DC. Acute kidney injury and chronic kidney disease in hospitalized patients with cirrhosis. J Investig Med. 2011; 59:1244–1251.

11. Ruíz-del-Árbol L, Achécar L, Serradilla R, et al. Diastolic dysfunction is a predictor of poor outcomes in patients with cirrhosis, portal hypertension, and a normal creatinine. Hepatology. 2013; 58:1732–1741.

12. Acevedo J, Fernández J, Prado V, et al. Relative adrenal insufficiency in decompensated cirrhosis: relationship to short-term risk of severe sepsis, hepatorenal syndrome, and death. Hepatology. 2013; 58:1757–1765.

13. Kim G, Huh JH, Lee KJ, Kim MY, Shim KY, Baik SK. Relative adrenal insufficiency in patients with cirrhosis: a systematic review and meta-analysis. Dig Dis Sci. 2017; 62:1067–1079.

14. Wong F. Recent advances in our understanding of hepatorenal syndrome. Nat Rev Gastroenterol Hepatol. 2012; 9:382–391.

15. Schrier RW, Arroyo V, Bernardi M, Epstein M, Henriksen JH, Rodés J. Peripheral arterial vasodilation hypothesis: a proposal for the initiation of renal sodium and water retention in cirrhosis. Hepatology. 1988; 8:1151–1157.

16. Ruiz-del-Arbol L, Monescillo A, Arocena C, et al. Circulatory function and hepatorenal syndrome in cirrhosis. Hepatology. 2005; 42:439–447.

17. Ruiz-del-Arbol L, Urman J, Fernández J, et al. Systemic, renal, and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis. Hepatology. 2003; 38:1210–1218.

18. Arroyo V, Colmenero J. Ascites and hepatorenal syndrome in cirrhosis: pathophysiological basis of therapy and current management. J Hepatol. 2003; 38:Suppl 1. S69–S89.

19. Schrier RW, Shchekochikhin D, Ginès P. Renal failure in cirrhosis: prerenal azotemia, hepatorenal syndrome and acute tubular necrosis. Nephrol Dial Transplant. 2012; 27:2625–2628.

20. Filomia R, Maimone S, Caccamo G, et al. Acute kidney injury in cirrhotic patients undergoing contrast-enhanced computed tomography. Medicine (Baltimore). 2016; 95:e4836.

21. Arroyo V, Ginès P, Gerbes AL, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International ascites club. Hepatology. 1996; 23:164–176.

22. Orlando R, Floreani M, Padrini R, Palatini P. Evaluation of measured and calculated creatinine clearances as glomerular filtration markers in different stages of liver cirrhosis. Clin Nephrol. 1999; 51:341–347.

23. Sherman DS, Fish DN, Teitelbaum I. Assessing renal function in cirrhotic patients: problems and pitfalls. Am J Kidney Dis. 2003; 41:269–278.

24. Caregaro L, Menon F, Angeli P, et al. Limitations of serum creatinine level and creatinine clearance as filtration markers in cirrhosis. Arch Intern Med. 1994; 154:201–205.

25. Spencer K. Analytical reviews in clinical biochemistry: the estimation of creatinine. Ann Clin Biochem. 1986; 23(Pt 1):1–25.

26. Angeli P, Gines P, Wong F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. Gut. 2015; 64:531–537.

27. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute Dialysis Quality Initiative workgroup. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004; 8:R204–R212.

28. Jenq CC, Tsai MH, Tian YC, et al. RIFLE classification can predict short-term prognosis in critically ill cirrhotic patients. Intensive Care Med. 2007; 33:1921–1930.

29. Cholongitas E, Calvaruso V, Senzolo M, et al. RIFLE classification as predictive factor of mortality in patients with cirrhosis admitted to intensive care unit. J Gastroenterol Hepatol. 2009; 24:1639–1647.

30. Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007; 11:R31.

31. Lassnigg A, Schmidlin D, Mouhieddine M, et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol. 2004; 15:1597–1605.

32. Tu KH, Jenq CC, Tsai MH, et al. Outcome scoring systems for short-term prognosis in critically ill cirrhotic patients. Shock. 2011; 36:445–450.

33. Radhakrishnan J, Cattran DC. The KDIGO practice guideline on glomerulonephritis: reading between the (guide)lines--application to the individual patient. Kidney Int. 2012; 82:840–856.

34. Pan HC, Chien YS, Jenq CC, et al. Acute kidney injury classification for critically ill cirrhotic patients: a comparison of the KDIGO, AKIN, and RIFLE classifications. Sci Rep. 2016; 6:23022.

35. Angeli P, Gatta A, Caregaro L, et al. Tubular site of renal sodium retention in ascitic liver cirrhosis evaluated by lithium clearance. Eur J Clin Invest. 1990; 20:111–117.

36. Francoz C, Prié D, Abdelrazek W, et al. Inaccuracies of creatinine and creatinine-based equations in candidates for liver transplantation with low creatinine: impact on the model for end-stage liver disease score. Liver Transpl. 2010; 16:1169–1177.

37. Wong F, O'Leary JG, Reddy KR, et al. New consensus definition of acute kidney injury accurately predicts 30-day mortality in patients with cirrhosis and infection. Gastroenterology. 2013; 145:1280–1288.

38. Boyer TD, Sanyal AJ, Garcia-Tsao G, et al. Predictors of response to terlipressin plus albumin in hepatorenal syndrome (HRS) type 1: relationship of serum creatinine to hemodynamics. J Hepatol. 2011; 55:315–321.

39. Rodríguez E, Elia C, Solà E, et al. Terlipressin and albumin for type-1 hepatorenal syndrome associated with sepsis. J Hepatol. 2014; 60:955–961.

40. Thursz MR, Richardson P, Allison M, et al. Prednisolone or pentoxifylline for alcoholic hepatitis. N Engl J Med. 2015; 372:1619–1628.

41. Dong T, Aronsohn A, Gautham Reddy K, Te HS. Rifaximin decreases the incidence and severity of acute kidney injury and hepatorenal syndrome in cirrhosis. Dig Dis Sci. 2016; 61:3621–3626.

42. Vlachogiannakos J, Viazis N, Vasianopoulou P, Vafiadis I, Karamanolis DG, Ladas SD. Long-term administration of rifaximin improves the prognosis of patients with decompensated alcoholic cirrhosis. J Gastroenterol Hepatol. 2013; 28:450–455.

43. Sharma BC, Sharma P, Lunia MK, Srivastava S, Goyal R, Sarin SK. A randomized, double-blind, controlled trial comparing rifaximin plus lactulose with lactulose alone in treatment of overt hepatic encephalopathy. Am J Gastroenterol. 2013; 108:1458–1463.

44. Wong F. Drug insight: the role of albumin in the management of chronic liver disease. Nat Clin Pract Gastroenterol Hepatol. 2007; 4:43–51.

45. Garcia-Martinez R, Caraceni P, Bernardi M, Gines P, Arroyo V, Jalan R. Albumin: pathophysiologic basis of its role in the treatment of cirrhosis and its complications. Hepatology. 2013; 58:1836–1846.

46. Garcia-Martinez R, Noiret L, Sen S, Mookerjee R, Jalan R. Albumin infusion improves renal blood flow autoregulation in patients with acute decompensation of cirrhosis and acute kidney injury. Liver Int. 2015; 35:335–343.

47. Sort P, Navasa M, Arroyo V, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med. 1999; 341:403–409.

48. Sigal SH, Stanca CM, Fernandez J, Arroyo V, Navasa M. Restricted use of albumin for spontaneous bacterial peritonitis. Gut. 2007; 56:597–599.

49. de Araujo A, de Barros Lopes A, Rossi G, et al. Low-dose albumin in the treatment of spontaneous bacterial peritonitis: should we change the standard treatment? Gut. 2012; 61:1371–1372.

50. Thévenot T, Bureau C, Oberti F, et al. Effect of albumin in cirrhotic patients with infection other than spontaneous bacterial peritonitis. A randomized trial. J Hepatol. 2015; 62:822–830.

51. Neri S, Pulvirenti D, Malaguarnera M, et al. Terlipressin and albumin in patients with cirrhosis and type I hepatorenal syndrome. Dig Dis Sci. 2008; 53:830–835.

52. Martín-Llahí M, Pépin MN, Guevara M, et al. Terlipressin and albumin vs albumin in patients with cirrhosis and hepatorenal syndrome: a randomized study. Gastroenterology. 2008; 134:1352–1359.

53. Ortega R, Ginès P, Uriz J, et al. Terlipressin therapy with and without albumin for patients with hepatorenal syndrome: results of a prospective, nonrandomized study. Hepatology. 2002; 36:941–948.

54. Sanyal AJ, Boyer T, Garcia-Tsao G, et al. A randomized, prospective, double-blind, placebo-controlled trial of terlipressin for type 1 hepatorenal syndrome. Gastroenterology. 2008; 134:1360–1368.

55. Sanyal AJ, Boyer TD, Frederick RT, et al. Reversal of hepatorenal syndrome type 1 with terlipressin plus albumin vs. placebo plus albumin in a pooled analysis of the OT-0401 and REVERSE randomised clinical studies. Aliment Pharmacol Ther. 2017; 45:1390–1402.

56. Egerod Israelsen M, Gluud LL, Krag A. Acute kidney injury and hepatorenal syndrome in cirrhosis. J Gastroenterol Hepatol. 2015; 30:236–243.

57. Cavallin M, Piano S, Romano A, et al. Terlipressin given by continuous intravenous infusion versus intravenous boluses in the treatment of hepatorenal syndrome: a randomized controlled study. Hepatology. 2016; 63:983–992.

58. Nazar A, Pereira GH, Guevara M, et al. Predictors of response to therapy with terlipressin and albumin in patients with cirrhosis and type 1 hepatorenal syndrome. Hepatology. 2010; 51:219–226.

59. Facciorusso A, Chandar AK, Murad MH, et al. Comparative efficacy of pharmacological strategies for management of type 1 hepatorenal syndrome: a systematic review and network meta-analysis. Lancet Gastroenterol Hepatol. 2017; 2:94–102.

60. Sharma P, Kumar A, Shrama BC, Sarin SK. An open label, pilot, randomized controlled trial of noradrenaline versus terlipressin in the treatment of type 1 hepatorenal syndrome and predictors of response. Am J Gastroenterol. 2008; 103:1689–1697.

61. Singh V, Ghosh S, Singh B, et al. Noradrenaline vs. terlipressin in the treatment of hepatorenal syndrome: a randomized study. J Hepatol. 2012; 56:1293–1298.

62. Nassar Junior AP, Farias AQ, D'Albuquerque LA, Carrilho FJ, Malbouisson LM. Terlipressin versus norepinephrine in the treatment of hepatorenal syndrome: a systematic review and meta-analysis. PLoS One. 2014; 9:e107466.

63. Nadim MK, Durand F, Kellum JA, et al. Corrigendum to “management of the critically ill patients with cirrhosis: a multidisciplinary perspective”. J Hepatol. 2016; 65:452.

64. Wong F, Pantea L, Sniderman K. Midodrine, octreotide, albumin, and TIPS in selected patients with cirrhosis and type 1 hepatorenal syndrome. Hepatology. 2004; 40:55–64.

65. Esrailian E, Pantangco ER, Kyulo NL, Hu KQ, Runyon BA. Octreotide/Midodrine therapy significantly improves renal function and 30-day survival in patients with type 1 hepatorenal syndrome. Dig Dis Sci. 2007; 52:742–748.

66. Skagen C, Einstein M, Lucey MR, Said A. Combination treatment with octreotide, midodrine, and albumin improves survival in patients with type 1 and type 2 hepatorenal syndrome. J Clin Gastroenterol. 2009; 43:680–685.

67. Cavallin M, Kamath PS, Merli M, et al. Terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of hepatorenal syndrome: a randomized trial. Hepatology. 2015; 62:567–574.

68. Wong LP, Blackley MP, Andreoni KA, Chin H, Falk RJ, Klemmer PJ. Survival of liver transplant candidates with acute renal failure receiving renal replacement therapy. Kidney Int. 2005; 68:362–370.

69. Guevara M, Gines P, Bandi JC, et al. Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: effects on renal function and vasoactive systems. Hepatology. 1998; 28:416–422.

70. Rössle M, Gerbes AL. TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax: a critical update. Gut. 2010; 59:988–1000.

71. Brensing KA, Textor J, Perz J, et al. Long term outcome after transjugular intrahepatic portosystemic stent-shunt in non-transplant cirrhotics with hepatorenal syndrome: a phase II study. Gut. 2000; 47:288–295.

72. Senzolo M, Cholongitas E, Tibballs J, Burroughs A, Patch D. Transjugular intrahepatic portosystemic shunt in the management of ascites and hepatorenal syndrome. Eur J Gastroenterol Hepatol. 2006; 18:1143–1150.

73. Wong F, Sniderman K, Liu P, Allidina Y, Sherman M, Blendis L. Transjugular intrahepatic portosystemic stent shunt: effects on hemodynamics and sodium homeostasis in cirrhosis and refractory ascites. Ann Intern Med. 1995; 122:816–822.

74. Trebicka J. Emergency TIPS in a child-pugh B patient: when does the window of opportunity open and close? J Hepatol. 2017; 66:442–450.

75. Jalan R, Sen S, Steiner C, Kapoor D, Alisa A, Williams R. Extracorporeal liver support with molecular adsorbents recirculating system in patients with severe acute alcoholic hepatitis. J Hepatol. 2003; 38:24–31.

76. Mitzner SR, Stange J, Klammt S, et al. Improvement of hepatorenal syndrome with extracorporeal albumin dialysis MARS: results of a prospective, randomized, controlled clinical trial. Liver Transpl. 2000; 6:277–286.

77. Wong F, Raina N, Richardson R. Molecular adsorbent recirculating system is ineffective in the management of type 1 hepatorenal syndrome in patients with cirrhosis with ascites who have failed vasoconstrictor treatment. Gut. 2010; 59:381–386.

78. Nair S, Verma S, Thuluvath PJ. Pretransplant renal function predicts survival in patients undergoing orthotopic liver transplantation. Hepatology. 2002; 35:1179–1185.

79. Marik PE, Wood K, Starzl TE. The course of type 1 hepato-renal syndrome post liver transplantation. Nephrol Dial Transplant. 2006; 21:478–482.

80. Wong F, Leung W, Al Beshir M, Marquez M, Renner EL. Outcomes of patients with cirrhosis and hepatorenal syndrome type 1 treated with liver transplantation. Liver Transpl. 2015; 21:300–307.

81. Nadim MK, Kellum JA, Davenport A, et al. Hepatorenal syndrome: the 8th international consensus conference of the Acute Dialysis Quality Initiative (ADQI) group. Crit Care. 2012; 16:R23.

82. Boyer TD, Sanyal AJ, Garcia-Tsao G, et al. Impact of liver transplantation on the survival of patients treated for hepatorenal syndrome type 1. Liver Transpl. 2011; 17:1328–1332.

83. Goldaracena N, Marquez M, Selzner N, et al. Living vs. deceased donor liver transplantation provides comparable recovery of renal function in patients with hepatorenal syndrome: a matched case-control study. Am J Transplant. 2014; 14:2788–2795.

84. Lee JP, Kwon HY, Park JI, et al. Clinical outcomes of patients with hepatorenal syndrome after living donor liver transplantation. Liver Transpl. 2012; 18:1237–1244.

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