Prognosis of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis: A Prospective Cohort Study

الملخص EN

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.