Why and how to measure renal functioon in patients with liver disease


Patients with advanced liver disease frequently have impaired renal function. Both acute kidney injury ( AKI ) and chronic kidney disease ( CKD ) are quite common in patients with cirrhosis and both are associated with a worse prognosis in these patients. A careful assessment of renal function is highly important in these patients to help physicians determine their diagnosis, prognosis and therapeutic management and to define transplantation strategies (liver transplantation alone vs simultaneous liver and kidney transplantation). Although they are still widely used in clinical practice, conven- tional biomarkers of renal function such as serum creatinine have several limitations in these patients. Recent progress has been made in the evaluation of renal function and new diagnostic criteria for AKI have been proposed. However, certain issues such as the noninvasive assessment of the glomerular filtration rate and/or improvement in the differential diagnosis between hepatorenal syndrome and acute tubular necrosis must still be addressed. The purposes of this paper are: (i) to highlight the importance of the evaluation of renal function in patients with cirrhosis; (ii) to review the state of the art in the assessment of renal function in these patients as well as advances that we expect will be made to improve the accuracy of available tools.

acute kidney injury , acute tubular necrosis , chronic kidney disease , hepatorenal syndrome , liver

About Speaker


Full Professor of Internal Medicine


City: Padova

Institution: Department of Medicine (DIMED), University of Padova

Contact: pangeli@unipd.it

Biography of Paolo ANGELI

Prof. Paolo Angeli is Full Professor of Internal Medicine. He is the head of Unit of Internal Medicine and Hepatology of the University of Padova (Italy). He leads a research group working on the pathophysiology and treatment of acute, chronic and acute on chronic liver failure and on liver transplantation. He is the present secretary of the International Club of Ascites. He is author of more than 220 papers on international journals with peer review, cited by JCR. He has contributed to the guidelines and/or positional papers on the management of ascites, bacterial infections and acute renal injury (AKI) in patients with cirrhosis for the European Association for the Study of the Liver. He has contributed to the new diagnostic criteria for AKI in patients with cirrhosis as a result of a consensus process with almost all the international experts in this field.

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