Sequential changes in urinary biomarker levels in patients with cirrhosis and severe hepatorenal syndrome
Cristina Solé
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Search for more papers by this authorAnn T. Ma
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Search for more papers by this authorElsa Solà
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
Search for more papers by this authorMarta Carol
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
Faculty of Medicine and Health Sciences, School of Nursing, Clinic Campus, University of Barcelona, Barcelona, Spain
Search for more papers by this authorNúria Fabrellas
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
Faculty of Medicine and Health Sciences, School of Nursing, Clinic Campus, University of Barcelona, Barcelona, Spain
Search for more papers by this authorAdrià Juanola
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Search for more papers by this authorLaura Napoleone
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Search for more papers by this authorJordi Gratacós-Ginès
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Search for more papers by this authorOctavi Bassegoda
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Search for more papers by this authorMarta Cervera
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
Faculty of Medicine and Health Sciences, School of Nursing, Clinic Campus, University of Barcelona, Barcelona, Spain
Search for more papers by this authorMartina Pérez
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Faculty of Medicine and Health Sciences, School of Nursing, Clinic Campus, University of Barcelona, Barcelona, Spain
Search for more papers by this authorAna Belén Rubio
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Faculty of Medicine and Health Sciences, School of Nursing, Clinic Campus, University of Barcelona, Barcelona, Spain
Search for more papers by this authorEmma Avitabile
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Search for more papers by this authorManuel Morales-Ruiz
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
Biochemistry and Molecular Genetics Department. Hospital Clínic, Department of Biomedicine-Biochemistry Unit, School of Medicine, University of Barcelona, Barcelona, Spain
Search for more papers by this authorIsabel Graupera
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
Search for more papers by this authorElisa Pose
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
Search for more papers by this authorPatrick S. Kamath
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
Search for more papers by this authorCorresponding Author
Pere Ginès
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
Faculty of Medicine and Health Sciences, School of Nursing, Clinic Campus, University of Barcelona, Barcelona, Spain
Correspondence
Pere Ginès, Liver Unit, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain.
Email: [email protected]
Search for more papers by this authorCristina Solé
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Search for more papers by this authorAnn T. Ma
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Search for more papers by this authorElsa Solà
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
Search for more papers by this authorMarta Carol
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
Faculty of Medicine and Health Sciences, School of Nursing, Clinic Campus, University of Barcelona, Barcelona, Spain
Search for more papers by this authorNúria Fabrellas
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
Faculty of Medicine and Health Sciences, School of Nursing, Clinic Campus, University of Barcelona, Barcelona, Spain
Search for more papers by this authorAdrià Juanola
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Search for more papers by this authorLaura Napoleone
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Search for more papers by this authorJordi Gratacós-Ginès
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Search for more papers by this authorOctavi Bassegoda
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Search for more papers by this authorMarta Cervera
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
Faculty of Medicine and Health Sciences, School of Nursing, Clinic Campus, University of Barcelona, Barcelona, Spain
Search for more papers by this authorMartina Pérez
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Faculty of Medicine and Health Sciences, School of Nursing, Clinic Campus, University of Barcelona, Barcelona, Spain
Search for more papers by this authorAna Belén Rubio
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Faculty of Medicine and Health Sciences, School of Nursing, Clinic Campus, University of Barcelona, Barcelona, Spain
Search for more papers by this authorEmma Avitabile
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Search for more papers by this authorManuel Morales-Ruiz
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
Biochemistry and Molecular Genetics Department. Hospital Clínic, Department of Biomedicine-Biochemistry Unit, School of Medicine, University of Barcelona, Barcelona, Spain
Search for more papers by this authorIsabel Graupera
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
Search for more papers by this authorElisa Pose
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
Search for more papers by this authorPatrick S. Kamath
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
Search for more papers by this authorCorresponding Author
Pere Ginès
Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain
Faculty of Medicine and Health Sciences, School of Nursing, Clinic Campus, University of Barcelona, Barcelona, Spain
Correspondence
Pere Ginès, Liver Unit, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain.
Email: [email protected]
Search for more papers by this authorHandling Editor: Minneke Coenraad
Funding information
Supported by a grant to PG (PI16/00043 and PI20/00579), integrated in the Plan Nacional Investigación Científica, Desarrollo e Innovación Tecnológica (I + D + I) and cofunded by Instituto Carlos III (ISCIII)-Subdirección General de Evaluación and the European Regional Development Fund. AJ is funded by Contratos Río Hortega (CM19/00044) granted by Instituto de Salud Carlos III. ES and GC are funded by Plan Nacional Investigación Cientifíca, Desarrollo e Innovación Tecnológica (I + D + I) and cofunded by Instituto Carlos III (ISCIII)-Subdirección General de Evaluación and the European Regional Development Fund (PI18/00727). ATM received financial support from the Canadian Association for the Study of the Liver (CASL) and the Canadian Liver Foundation (CLF). OB received financial support from Contracte Clínic de Recerca Emili Letang-Josep Font.
Abstract
Whether tubular injury develops in patients with acute kidney injury owing to hepatorenal syndrome (AKI-HRS) is controversial. We performed repeated measurements of biomarkers of tubular injury during a 14-day period in 60 patients with cirrhosis and AKI (34 with AKI-HRS meeting the classical definition of type 1 HRS and 26 with AKI owing to acute tubular necrosis, AKI-ATN). Nineteen of 34 patients had resolution of AKI-HRS, while the remainder had persistent AKI-HRS. The persistence of AKI-HRS was associated with remarkably high short-term mortality. There were no significant differences in urinary NGAL or IL-18 between patients with resolution vs those with persistent AKI-HRS throughout the 14-day period. By contrast, biomarker levels were significantly lower in AKI-HRS, even if persistent, compared to AKI-ATN. These findings are highly suggestive of lack of significant tubular injury in AKI-HRS and could be of value in the clinical decision between combined liver–kidney or liver transplantation alone in patients with cirrhosis and AKI candidates to transplantation.
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