AKI and CKD in Cirrhosis – Mitra Nadim
- GFR definitions are invalid in cirrhotic patients.
- Definately NOT to use – CKD-EPI and MDRD 4 but CAN use MDRD-6 based on review of literature.
- Classically AKI in cirrhotics is a tough diagnostic problem to rule out pre renal vs hepatorenal vs ATN. FeNa and albumin might help in pre renal vs HRS and ATN.
- A recent study is helping us on this matter significantly. A MUST READ.
- The fractional excretion of sodium (FENa) was lowest in patients with HRS, 0.10%, but did not differ between those with PRA, 0.27%, or ATN, 0.31%, P = 0.54. The likelihood of being diagnosed with ATN increased step-wise with the number of biomarkers above optimal diagnostic cutoffs.
- Hence a VERY LOW FENA might guide us towards HRS as most likely diagnosis.
Post written by Dr. Kenar Jhaveri, eAJKD Editor.