Renal dysfunction is a common complication in hospitalized patients with cirrhosis. The diagnosis of Type 1 HRS is one of exclusion and cannot be made until other causes of renal failure, particularly acute tubular necrosis (ATN), are ruled out. The treatment for ATN is solely supportive via hemodialysis, as vasoconstrictors and albumin will not improve renal function and may potentially worsen it. Differentiating between Type 1 HRS and ATN may be difficult and often takes several days, as traditionally-used distinguishing urinary parameters may be altered in advanced liver disease.
Additionally, determining which patients are at risk for progression of their AKI early in the course of the disease is challenging. Hence, crucial delays in diagnosis impair the ability to institute treatment earlier, which may lead to increased morbidity and mortality. Research in both experimental animals and humans has identified urine biomarkers that are capable of detecting renal tubular injury (a sine qua non for ATN) with a high degree of sensitivity and specificity as well as associating with progression of AKI.
In this prospective multicenter cohort study, we have to enrolled ~200 patients, from four major academic centers, with cirrhosis and renal dysfunction and are determining the efficacy of urinary IL-18, NGAL, KIM-1, and L-FABP in correctly identifying ATN in hospitalized patients with cirrhosis and renal dysfunction, thereby facilitating the diagnosis of Type 1 HRS. Additionally, we are evaluating the association between these biomarkers and AKI progression and mortality.
Virginia Commonwealth University
Arun Sanyal, MD - Co-Investigator
Jacobi Medical Center
Naheed Ansari, MD - Co-Investigator
- Belcher JM, Garcia-Tsao G, Sanyal AJ, Bhogal H, Lim JK, Ansari N, Coca SG, Parikh CR, TRIBE-AKI Consortium.: Association of AKI with mortality and complications in hospitalized patients with cirrhosis. Hepatology. 2013 Feb; 2012 Dec 6. PMID: 22454364
- Garcia-Tsao G, Parikh CR, Viola A: Acute kidney injury in cirrhosis. Hepatology. 2008 Dec. PMID: 19003880