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©The Author(s) 2025.
World J Hepatol. May 27, 2025; 17(5): 104724
Published online May 27, 2025. doi: 10.4254/wjh.v17.i5.104724
Published online May 27, 2025. doi: 10.4254/wjh.v17.i5.104724
Table 2 Serum biomarkers, urinary biomarkers, and hemodynamic parameters to differentiate among pre-renal acute kidney injury, acute tubular necrosis, and hepatorenal syndrome
Parameters | Pre-renal AKI | Hepatorenal syndrome | Acute tubular necrosis | Comments |
Clue to diagnose | History of fluid loss or overzealous use of diuretics | Presence of refractory ascites, hyponatremia | Presence of sepsis and hypotension | History cannot be always reliable to diagnose the subtypes of kidney injury |
Urine sediments[73,74] | The lack of any casts suggests functional renal failure mostly pre-renal AKI[56] | Usually absent | Muddy brown casts and renal tubular epithelial cell casts | Should be interpreted by expert renal pathologists |
Sensitivity: 73% | RETC and granular cast | |||
Specificity: 75% | PPV: 100% | |||
However, bland, hyaline cast may be present | NPV: 40% | |||
FENa[27,75] | < 1 | < 1 for diagnosing HRS-AKI | Usually > 1 | FENa is unable to distinguish between Pre-renal AKI and HRS-AKI |
Sensitivity: 90% | Sensitivity: 100% | Sensitivity: 89% | Not validated in patients on diuretics | |
Specificity: 82% | Specificity: 14% | Specificity: 71% | FENa can be < 1 in patients with cirrhosis without AKI | |
To differentiate between intrinsic vs pre-renal kidney injury | AASLD | FENa < 0.56 excludes ATN | ||
< 0.1 suggests HRS[46] | ||||
FEUrea[29] | < 21 | < 28.7 | > 33 | No standardized cut-off in patients with cirrhosis |
Sensitivity: 90% | Sensitivity: 75% | < 34 to rule out ATN | ||
Specificity: 61% | Specificity: 83% | Sensitivity: 70% | ||
For PRA vs HRS | For non-HRS vs HRS | Specificity: 58% | ||
NGAL-1[35,36,38,39] | < 110 | < 100 | > 194 mcg/g Cr | |
Sensitivity: 88% | Sensitivity: 91% | |||
Specificity: 85% | Specificity: 82% | |||
Renal artery resistive index[76,77] | Cannot differentiate between prerenal AKI and AKI-HRS | > 0.7 predicts HRS[76] | > 0.8 is suggestive of ATN[77] | RARI is higher in patients with cirrhosis and ascites compared to healthy individuals |
> 0.77 predicts HRS in cirrhosis | RARI is higher in ATN than in HRS. | |||
Sensitivity: 100% | ||||
Specificity: 77% |
- Citation: Malakar S, Rungta S, Samanta A, Shamsul Hoda U, Mishra P, Pande G, Roy A, Giri S, Rai P, Mohindra S, Ghoshal UC. Understanding acute kidney injury in cirrhosis: Current perspective. World J Hepatol 2025; 17(5): 104724
- URL: https://www.wjgnet.com/1948-5182/full/v17/i5/104724.htm
- DOI: https://dx.doi.org/10.4254/wjh.v17.i5.104724