title: Acute kidney injury in patients with cirrhosis: perils and promise.
abstract: A 62-year-old man with cirrhosis secondary to hepatitis C and chronic alcohol abuse was admitted to the intensive care unit with hematemesis and mental status changes. Physical examination showed ascites and stigmata of chronic liver disease. Blood pressure was noted as 87/42 mm Hg and laboratory studies showed a serum creatinine level of 0.8 mg/dL, an estimated glomerular filtration rate of 84 mL/min/1.73 m(2) calculated using the Modification of Diet in Renal Disease Study equation, a serum sodium level of 123 mEq/L, a total serum bilirubin level of 4.3 mg/dL, and an international normalization ratio of 1.6. The patient was resuscitated with packed red blood cells and fresh-frozen plasma and bleeding was controlled. However, on the third day of admission, creatinine level increased to 1.5 mg/dL. Examination of urine sediment showed 1 to 5 bilirubin-stained granular casts per high-powered field and a few renal tubular epithelial cells. The urine sodium level was 21 mEq/L and the fractional excretion of sodium was 0.43%.
authors.affiliation: Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut; Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut; Clinical Epidemiology Research Center, VA-Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Belcher
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Garcia-Tsao
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000473:pathology*; D000437:Alcoholism / Q000150:complications*; D001663:Bilirubin / Q000652:urine; D015415:Biomarkers; D003404:Creatinine / Q000097:blood; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012964:Sodium / Q000652:urine
chemical_list: D015415:Biomarkers; D012964:Sodium; D003404:Creatinine; D001663:Bilirubin
keywords: AKI; AKIN; ATN; Acute Kidney Injury Network; Acute Tubular Necrosis; Ascites; CKD; Cirrhosis; FENa; GFR; HRS; Hepatorenal; IAC; ICU; International Ascites Club; KIM-1; Kidney Injury; MDRD; Modification of Diet in Renal Disease; NGAL; OR; PRA; RAAS; Urinary Biomarkers; acute kidney injury; acute tubular necrosis; chronic kidney disease; fractional excretion of sodium; glomerular filtration rate; hepatorenal syndrome; intensive care unit; kidney injury molecule-1; neutrophil gelatinase–associated lipocalin; odds ratio; prerenal azotemia; renin-angiotensin-aldosterone system