Acute kidney injury in patients with chronic liver disease

Table 1 Diagnostic criteria and assessment of the severity of acute kidney injury according to the criterion of RIFLE, RIFLE/AKIN and KDIGO clinical practice guidelines classifications

Definition of AKI	Increased SCr × 1.5 the basal value presumably to have occurred within the prior 7 d or GFR decrease > 25% or urine output < 0.5 mL/kg per hour for 6 h	Increased SCr × 1.5 the basal value or ≥ 0.3 mg/dL within 48 h or urine output < 0.5 mL/kg per hour for > 6 h	Increased SCr ≥× 1.5 the basal value presumably to have occurred within the prior 7 d or ≥ 0.3 mg/dL (26.5 μmol/L) within 48 h or urine output < 0.5 mL/kg per hour for 6 h
Stage 1 (risk)	Increased SCr × 1.5 the basal value or GFR decrease > 25% or urine output< 0.5 mL/kg per hour for 6 h	Increased SCr × 1.5 to 2 the basal value or ≥ 0.3 mg/dL within 48 h or urine output < 0.5 mL/kg per hour for > 6 h	Increased SCr × 1.5 to 1.9 the basal value or ≥ 0.3 mg/dL or urine output < 0.5 mL/kg per hour for 6-12 h
Stage 2 (injury)	Increased SCr × 2 the basal value or GFR decrease > 50% or urine output < 0.5 mL/kg per hour for 12 h	Increased SCr × 2 to 3 the basal value or urine output < 0.5 mL/kg per hour for > 12 h	Increased SCr × 2 to 2.9 the basal value or urine output < 0.5 mL/kg per hour for ≥ 12 h
Stage 3 (failure)	Increased SCr × 3 the basal value or GFR decrease > 75% or SCr > 4 mg/dL with acute rise of ≥ 0.5 mg/dL or urine output < 0.3 mL/kg per hour for 24 h or anuria for 12 h	Increased SCr × 3 the basal value or ≥ 4 mg/dL (353.6 μmoL/L) with acute rise ≥ 0.5 mg/dL or initiation of RRT or urine output < 0.3 mL/kg per hour for ≥ 24 h or anuria for ≥ 12 h	Increased SCr × 3 the basal value or ≥ 4 mg/dL (353.6 μmol/L) or initiation of RRT or urine output < 0.3 mL/kg per hour for ≥ 24 h or anuria for ≥ 12 h

SCr: Serum Creatinine; GFR: Glomerular filtration rate; RRT: Renal replacement therapy; AKI: Acute kidney injury.

Table 2 Diagnostic criteria of type 1 hepatorenal syndrome porposed by the international ascites club[25]

Cirrhosis with ascites

SCr > 1.5 mg/dL (133 μmol/L)

Doubling of basal SCr to a level greater than 2.5 mg/dL (226 μmol/L) in less than 2 wk

No improvement in SCr (decrease to 1.5 mg/dL or less) after at least 2 d of diuretic withdrawal and expansion of plasma volume with albumin (1 g/kg body weight/d up to a maximum of 100 g/d)

Absence of shock

No current or recent treatment with nephrotoxic drugs or vasodilators

Absence of parenchymal kidney disease as indicated by proteinuria > 0.5 g/d, hematuria (> 50 red blood cells per high-power field), or abnormal renal ultrasonography

SCr: Serum creatinine.