title: Predicting the development of acute kidney injury in liver cirrhosis--an analysis of glomerular filtration rate, proteinuria and kidney injury biomarkers.
abstract: BACKGROUND
  The timely diagnosis of acute kidney injury (AKI) in liver cirrhosis is challenging.
  
  
  OBJECTIVE
  To evaluate whether quantification of glomerular filtration rate (GFR), proteinuria and kidney injury biomarkers can accurately predict the development of AKI.
  
  
  METHODS
  A prospective cohort analysis of patients with cirrhosis was performed. Measures of baseline kidney function included serum creatinine, iohexol clearance and urine protein:creatinine ratio. Blood and urine samples were collected daily. A retrospective analysis of cystatin C GFR and neutrophil gelatinase-associated lipocalin (NGAL) measured 48 h prior to the diagnosis of AKI was undertaken to evaluate their ability to predict the development of AKI.
  
  
  RESULTS
  Eighteen of the 34 cirrhosis patients studied developed AKI. A GFR <60 mL/min/1.73 m(2) was identified in 56% with Iohexol clearance compared to 8% using the four-variable modified diet in renal disease formula (P < 0.0001). Prediction of AKI, 48 h prior to the development of AKI with cystatin C GFR and serum NGAL concentration were similar; area under the receiver operating curve (AUROC) values 0.74 (0.51-0.97), P = 0.04 and 0.72 (0.52-0.92), P = 0.02 respectively. The development of AKI was strongly predicted by urine protein:creatinine ratio above the cut-off of >30 (equivalent to 300 mg/day of proteinuria) sensitivity 82% (57-96) and specificity 80% (52-96), AUROC 0.86 (0.73-0.98), P ≤ 0.0001. [OR 21 (3-133), P ≤ 0.002].
  
  
  CONCLUSIONS
  In patients with liver cirrhosis a urine protein:creatinine ratio >30 predicts AKI. Iohexol clearance and cystatin C formulae identify a greater proportion of patients with a GFR <60 mL/min/1.73 m(2), which also predicts the development of AKI.
authors.affiliation: Institute of Liver Studies, King's College Hospital Foundation Trust, London, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Slack
authors.forename: M J W
authors.initials: MJ
authors.lastname: McPhail
authors.forename: M
authors.initials: M
authors.lastname: Ostermann
authors.forename: M
authors.initials: M
authors.lastname: Bruce
authors.forename: R
authors.initials: R
authors.lastname: Sherwood
authors.forename: R
authors.initials: R
authors.lastname: Musto
authors.forename: T
authors.initials: T
authors.lastname: Dew
authors.forename: G
authors.initials: G
authors.lastname: Auzinger
authors.forename: W
authors.initials: W
authors.lastname: Bernal
authors.forename: J
authors.initials: J
authors.lastname: O'Grady
authors.forename: M A
authors.initials: MA
authors.lastname: Heneghan
authors.forename: K
authors.initials: K
authors.lastname: Moore
authors.forename: J A
authors.initials: JA
authors.lastname: Wendon
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology; D000209:Acute-Phase Proteins / Q000652:urine; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood / Q000652:urine; D015331:Cohort Studies; D003287:Contrast Media / Q000493:pharmacokinetics; D003404:Creatinine / Q000097:blood / Q000652:urine; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007472:Iohexol / Q000493:pharmacokinetics; D007677:Kidney Function Tests; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood / Q000652:urine; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011507:Proteinuria / Q000175:diagnosis*; D011518:Proto-Oncogene Proteins / Q000097:blood / Q000652:urine
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D003287:Contrast Media; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D007472:Iohexol; D003404:Creatinine