Kidney Week 2014: The Kidney-Liver Service – Part 2

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. 

Check out more of eAJKD’s coverage of Kidney Week 2014, including part 1 of the kidney-liver service. Also, follow @eAJKD on Twitter for live updates!

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