Acute kidney injury (AKI) is a serious complication in patients with liver cirrhosis. Prompt recognition using criteria adapted for this population is essential to initiating the appropriate management strategy.
Clinical scenario: In patients with cirrhosis, AKI is 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.
Approach: Management centres on reviewing diuretic use and albumin-based volume expansion; patients presenting with concurrent ascites require an additional specific intervention alongside this strategy — details are in 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).
In case of no obvious cause of AKI, AKI stage >1A or infection-induced AKI, 20% albumin solution should be used at the dose of 1 g of albumin/kg of body weight (with a maximum of 100 g of albumin) for two consecutive days (III,1).
In patients with AKI and tense ascites, therapeutic paracentesis should be associated with albumin infusion even when a low volume of ascitic fluid is removed (III,1).
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