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Kidney biomarkers in cirrhosis
Claire Francoz1, Mitra K Nadim2, François Durand1
1Hepatology and Liver Intensive Care, Hospital Beaujon, Clichy, France; University Paris VII Diderot, Paris, France; INSERM U1149, Paris, France; Département Hospitalo-Universitaire UNITY, Clichy, France.
Journal of Hepatology
|May 31, 2016
Summary
Diagnosing kidney impairment in cirrhosis is crucial. New biomarkers show promise for differentiating causes and predicting recovery, aiding liver and kidney transplant decisions.
Area of Science:
- Nephrology
- Hepatology
- Biomarker Discovery
Background:
- Impaired renal function, including acute kidney injury (AKI) and chronic kidney disease (CKD), is common in cirrhosis.
- Distinguishing between functional renal impairment (prerenal, hepatorenal syndrome) and acute tubular necrosis (ATN) is critical for patient management.
- AKI and CKD may represent a continuum, impacting the potential for full renal recovery in cirrhotic patients.
Purpose of the Study:
- To review current and emerging biomarkers for assessing renal function in cirrhosis.
- To identify biomarkers that can differentiate causes of kidney injury, such as ATN versus hepatorenal syndrome.
- To explore biomarkers for predicting renal reversibility and guiding treatment decisions, including transplantation.
Main Methods:
- Review of existing literature on renal biomarkers in cirrhosis.
- Evaluation of diagnostic accuracy of current markers like creatinine and cystatin C for glomerular filtration rate.
- Assessment of novel biomarkers, including neutrophil gelatinase-associated lipocalin and urinary microRNAs, for differentiating kidney injury types.
Main Results:
- Creatinine is inaccurate for assessing glomerular filtration rate in CKD; exogenous markers are preferred.
- Neutrophil gelatinase-associated lipocalin is studied but lacks clear differentiating values between ATN and hepatorenal syndrome.
- No gold standard exists for comparing ATN and hepatorenal syndrome in cirrhosis; combinations of biomarkers are promising.
Conclusions:
- Accurate biomarkers for underlying CKD and kidney fibrosis in cirrhosis are needed.
- Urinary microRNAs show potential but require further validation.
- Developing biomarkers for maladaptive repair post-AKI is essential for predicting irreversible CKD.
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