Acute kidney injury (AKI) is a recognised complication in patients with liver cirrhosis. When kidney function deteriorates acutely, a structured and timely management approach is required to limit further renal harm.
This protocol applies to patients with liver cirrhosis who develop AKI, defined by an increase in serum creatinine of at least 0.3 mg/dl within 48 hours, or an increase of at least 50% from baseline within three months — based on adapted KDIGO criteria for the cirrhotic population.
Initial management centers on close monitoring and prompt removal of contributing risk factors, including withdrawal of drug classes known to precipitate AKI. Volume replacement is also addressed according to the cause and extent of fluid loss. The full protocol specifies additional steps, decision criteria, and sequencing not shown here.
Complete regimen and clinical algorithm available via the full protocol.
DOI: 10.1016/j.jhep.2018.03.024
In patients with cirrhosis the diagnosis of AKI should be based on adapted KDIGO criteria, thus, either on an increase in SCr of >0.3 mg/dl from baseline within 48 h, or an increase of ≥50% from baseline within three months (II-2,1).
Diuretics and/or beta-blockers as well as other drugs that could be associated with the occurrence of AKI such as vasodilators, NSAIDs and nephrotoxic drugs should be immediately stopped (II-2,1).
Volume replacement should be used in accordance with the cause and severity of fluid losses (II-2,1).
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