AKI and CKD in Cirrhosis – Mitra Nadim

1. GFR definitions are invalid in cirrhotic patients.
2. Definately NOT to use – CKD-EPI and MDRD 4 but CAN use MDRD-6 based on review of literature.
3. 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.
4. A recent study is helping us on this matter significantly. A MUST READ.
5. 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.
6. Hence a VERY LOW FENA might guide us towards HRS as most likely diagnosis.

Post written by Dr. Kenar Jhaveri, eAJKD Editor. 

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