Review article: renal function assessment in cirrhosis - difficulties and alternative measurements.
BACKGROUND
Renal function in patients with cirrhosis is important prognostically, both before and following liver transplantation. Its prognostic impact is reflected by the inclusion of serum creatinine in the model for end-stage liver disease score, which is now used for recipient prioritization on liver transplantation waiting lists in the USA.


OBJECTIVE
To review the accuracy of the surrogate markers for the assessment of renal function, i.e. glomerular filtration rate, particularly in patients with cirrhosis.


METHODS
We reviewed the available literature in PubMed regarding the markers for GFR evaluation and the factors which affect their accuracy in cirrhosis.


RESULTS
Although creatinine is widely available, it is an unreliable marker of glomerular filtration rate, particularly in patients with cirrhosis. Clearance of exogenous markers is considered the 'gold standard', but this methodology has many drawbacks, particularly poor applicability. Several mathematical formulae for estimated glomerular filtration rate are used to overcome some of these limitations: Cockcroft-Gault and Modification of Diet in Renal Disease formulae are the most frequently applied, but they are based on serum creatinine.


CONCLUSIONS
Due to the inaccuracy of serum creatinine and its derived formulae in estimating glomerular filtration rate, alternative serum markers, such as cystatin C, and new formulae are desirable. These need formal evaluation in patients with cirrhosis so as to have a reliable surrogate of glomerular filtration rate, and to obviate many problems that are associated with using creatinine and estimated glomerular filtration rate.
Cholongitas
E
E
Liver Transplantation and Hepatobiliary Medicine Unit, Royal Free Hospital, London, UK.
Shusang
V
V
Marelli
L
L
Nair
D
D
Thomas
M
M
Patch
D
D
Burns
A
A
Sweny
P
P
Burroughs
A K
AK
D015415:Biomarkers / Q000378:metabolism; D055316:Cystatin C; D015891:Cystatins / Q000097:blood / Q000378:metabolism; D042241:Early Diagnosis; D005919:Glomerular Filtration Rate; D006801:Humans; D007677:Kidney Function Tests / Q000379:methods; D008103:Liver Cirrhosis / Q000150:complications*; D011237:Predictive Value of Tests; D051437:Renal Insufficiency / Q000209:etiology*; D015203:Reproducibility of Results; D016896:Treatment Outcome; D014481:United States
D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins