title: Working Party proposal for a revised classification system of renal dysfunction in patients with cirrhosis.
abstract: OBJECTIVE
  To propose an improvement on the current classification of renal dysfunction in cirrhosis. Clinicians caring for patients with cirrhosis recognize that the development of renal dysfunction is associated with significant morbidity and mortality. While most cases of renal dysfunction in cirrhosis are functional in nature, developed as a result of changes in haemodynamics, cardiac function, and renal auto-regulation, there is an increasing number of patients with cirrhosis and structural changes in their kidney as a cause of renal dysfunction. Therefore, there is a need for a newer classification to include both functional and structural renal diseases.
  
  
  METHODS
  A working party consisting of specialists from multiple disciplines conducted literature search and developed summary statements, incorporating the renal dysfunction classification used in nephrology. These were discussed and revised to produce this proposal.
  
  
  METHODS
  Multi-disciplinary international meeting.
  
  
  METHODS
  None.
  
  
  METHODS
  Literature search using keywords of cirrhosis, renal dysfunction, acute kidney injury (AKI), chronic kidney injury (CKD), and hepatorenal syndrome.
  
  
  RESULTS
  Acute kidney injury will include all causes of acute deterioration of renal function as indicated by an increase in serum creatinine of >50% from baseline, or a rise in serum creatinine of ≥ 26.4 µmol/L (≥ 0.3 mg/dL) in < 48 hours. Chronic renal disease will be defined as an estimated glomerular filtration rate (GFR) of < 60 ml/min calculated using the Modification of Diet in Renal Disease 6 (MDRD6) formula, recognising that the MDRD6 formula is not perfect for the cirrhotic patients and this may change as improved means of estimating GFR becomes available. Acute on chronic kidney disease will be defined as AKI superimposed on existing chronic renal disease using the above definitions for AKI and CKD.
  
  
  CONCLUSIONS
  Accepting this new classification will allow studies into the epidemiology, incidence, prevalence, natural history and the development of new treatments for these subtypes of renal dysfunction in cirrhosis.
authors.affiliation: Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario M5G2C4, Canada. florence.wong@utoronto.ca
authors.forename: Florence
authors.initials: F
authors.lastname: Wong
authors.forename: Mitra K
authors.initials: MK
authors.lastname: Nadim
authors.forename: John A
authors.initials: JA
authors.lastname: Kellum
authors.forename: Francesco
authors.initials: F
authors.lastname: Salerno
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.forename: Alexander
authors.initials: A
authors.lastname: Gerbes
authors.forename: Paolo
authors.initials: P
authors.lastname: Angeli
authors.forename: Richard
authors.initials: R
authors.lastname: Moreau
authors.forename: Andrew
authors.initials: A
authors.lastname: Davenport
authors.forename: Rajiv
authors.initials: R
authors.lastname: Jalan
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
authors.forename: Yuri
authors.initials: Y
authors.lastname: Genyk
authors.forename: Vicente
authors.initials: V
authors.lastname: Arroyo
mesh_terms: D058186:Acute Kidney Injury / Q000145:classification / Q000175:diagnosis / Q000209:etiology; D035843:Biomedical Research / Q000379:methods; D006530:Hepatorenal Syndrome / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007674:Kidney Diseases / Q000145:classification* / Q000175:diagnosis / Q000209:etiology*; D008103:Liver Cirrhosis / Q000150:complications*; D051436:Renal Insufficiency, Chronic / Q000145:classification / Q000175:diagnosis / Q000209:etiology; D009626:Terminology as Topic