title: Evaluation of renal function in patients with cirrhosis: where are we now?
abstract: In the clinical context of the patients with liver cirrhosis, accurate evaluation of the renal function is potentially crucial. Indeed, it can lead to early diagnosis of both acute kidney injury and chronic kidney disease and to reliable characterization of the renal status of the patient before performing a liver transplantation. Despite some limitations, the assay of serum creatinine (SCr) is universally used to estimate glomerular filtration rate (GFR) because of its wide availability, its simplicity and because it is inexpensive. Nevertheless, several reports show that the value of this assay to estimate GFR is strongly challenged in cirrhotic patients, especially in patients with liver failure and/or severely impaired renal function. This has led to seek new alternatives to estimate more reliably the GFR in these patients. Although the reference methods, based on the utilization of exogenous markers, allow measuring GFR and thereby constitute the "gold standard" to evaluate renal function, they are not feasible in routine clinical practice. Several studies have shown that a cystatin C (CysC) based formula perform better than the SCr-based estimates in cirrhotic patients and the estimation of GFR by these formulas could therefore lead to optimize the management of the patients. A new estimate based on CysC has been recently developed using a large number of patients and the first results regarding the evaluation of its performance are promising, making this new formula the best candidate for a reference estimate of the renal function in cirrhotic patients.
authors.affiliation: Nicolas Rognant, Sandrine Lemoine, Nephrology Department, Hospices Civils de Lyon, France and University Claude Bernard Lyon I, F-69008 Lyon, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Rognant
authors.affiliation: Nicolas Rognant, Sandrine Lemoine, Nephrology Department, Hospices Civils de Lyon, France and University Claude Bernard Lyon I, F-69008 Lyon, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Lemoine
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood; D042241:Early Diagnosis; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008954:Models, Biological; D011237:Predictive Value of Tests; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D015203:Reproducibility of Results
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D003404:Creatinine
keywords: Agreement; Cirrhosis; Cystatin C; Estimation; Formula; Glomerular filtration rate; Plasma creatinine