Point-of-Care Echocardiography Unveils Misclassification of Acute Kidney Injury as Hepatorenal Syndrome

American Journal of Nephrology
Juan Carlos Q VelezJohn Terrill Huggins

Abstract

Fulfillment of the diagnostic criteria for -hepatorenal syndrome type 1 (HRS-1) requires prior failure of 2 days of intravenous volume expansion and/or diuretic withdrawal. However, no parameter of volume status is used to guide the need for volume expansion in patients with suspected HRS-1. We hypothesized that point-of-care echocardiography (POCE) may better characterize the volume status in patients with acute kidney injury (AKI) and cirrhosis to ascertain or disprove the diagnosis of HRS-1. A pilot observational study was conducted to determine the clinical utility of POCE-based examination of inferior vena cava diameter (IVCD) and collapsibility index (IVCCI) to assess intravascular volume status in patients with cirrhosis and AKI who had been deemed adequately volume-repleted and thereby assigned a clinical diagnosis of HRS-1. Early improvement in kidney function was defined as ≥20% decrease in serum creatinine (sCr) at 48-72 h. A total of 53 patients were included. The mean sCr at the time of volume assessment was 3.2 ± 1.5 mg/dL, and the mean Model for End-Stage Liver Disease score was 29 ± 8. Fifteen (23%) patients had an IVCD <1.3 cm and IVCCI >40% and were reclassified as fluid-depleted, 11 (21%) had an IVCD >2 cm an...Continue Reading

Citations

Sep 16, 2020·BMJ : British Medical Journal·Douglas A SimonettoPatrick S Kamath
Nov 15, 2019·Nature Reviews. Nephrology·Juan Carlos Q VelezLuis A Juncos
Jan 14, 2021·Journal of Intensive Care Medicine·Madhumita PremkumarSmita Divyaveer
Apr 4, 2021·Diagnostics·Alejandro Meraz-MunozPrakash Gudsoorkar
Nov 16, 2021·Liver International : Official Journal of the International Association for the Study of the Liver·Kavish R PatidarEric S Orman

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