Prognosis of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis: A Prospective Cohort Study
Prognosis of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis: A Prospective Cohort Study
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DOI：
10.1155/2015/108139
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发表时间：
2015-01-01
影响因子：
2.1
通讯作者：
Thadhani, Ravi I.
中科院分区：
文献类型：
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作者：
Allegretti, Andrew S.;Ortiz, Guillermo;Thadhani, Ravi I.
背景/目标。急性肾损伤是肝硬化患者的常见问题，并且与较差的生存率相关。我们的目的是研究急性肾损伤类型与 90 天死亡率之间的关联。方法。美国一家主要肝移植中心的前瞻性队列研究。肾病专家对尿沉渣的审查与 2007 年腹水俱乐部标准结合使用，将急性肾损伤分为四组：肾前性氮质血症、肝肾综合征、急性肾小管坏死或其他。结果。对 120 名患有肝硬化和急性肾损伤的参与者进行了分析。肾前性氮质血症的 90 天死亡率为 14/40 (35%)，肝肾综合征的 90 天死亡率为 20/35 (57%)，急性肾小管坏死的 21/36 (58%)，其他疾病的 90 天死亡率为 1/9 (11%)（总体 p = 0.04）。与急性肾小管坏死相比，肝肾综合征的死亡率相同（p = 0.99）。与肝肾综合征 (p = 0.05) 和急性肾小管坏死 (p = 0.04) 相比，肾前性氮质血症的死亡率较低。由于尿沉渣上有颗粒管型，10 名参与者 (22%) 从肝肾综合征重新分类为急性肾小管坏死。结论。肝肾综合征和急性肾小管坏死导致的 90 天死亡率相似。尿沉渣检查可能会为该人群提供重要的诊断信息。需要多中心研究来验证这些发现并更好地指导管理。
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-daymortality. 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-daymortality. Review of urinary sediment may add important diagnostic information to this population. Multicenter studies are needed to validate these findings and better guide management.