Gastroenterologie
a hepatologie

Assessment of renal function in patients with liver disease

Vladimír Teplan ^{Orcid.org  1,2,3}

+ Affiliation
¹ Klinické a výzkumné centrum pro idiopatické střevní záněty ISCARE a.s. a 1. LF UK Praha
² Subkatedra nefrologie, Institut postgraduálního vzdělávání ve zdravotnictví, Praha
³ Katedra interních oboru LF OU, Ostrava

Summary

Accurate measurement of renal function in serious liver disease is very important not only for the estimation of renal damage (chronic kidney disease – CKD), safe drug management, prediction of illness follow-up, intensive methods including hemodialysis, hemodiafiltration or hemoperfusion, but also for the indication of liver transplantation. All methods of renal function measurement using serum creatinine for the estimation of glomerular filtration rate (GFR) are not accurate: they overestimate the value of GFR; the worse the liver damage is, the higher the level of overestimation; predominantly due to decreased endogenous creatinine production (creatinine generation rate – CGR). Using of cystatin C for GFR in liver disease is mainly promising in acute kidney injury (AKI), but obtained results have not been defi nitive yet and need more relevant data from diff erent methods of GFR estimation.

Keywords

kreatinin, chronic liver disease, chronic kidney disease, glomerulární filtrace, cystatin C

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Literature

1. Gines P, Schrier RW. Renal failure in cirrhosis. N Engl J Med 2009; 361(13): 1279–1290. doi: 10.1056/NEJMra0809139.
2. Teplan V. Nefrologické minimum pro klinickou praxi. 3. vyd. Praha: Maxdorf 2020.
3. Delanaye P, Cavalier E, Cristol JP et al. Calibration and precision of serum creatinine and plasma cystatin C measurement: impact on the estimation of glomerular filtration rate. J Nephrol 2014; 27(5): 467–475. doi: 10.1007/s40620-014-0087-7.
4. Davenport A, Cholongitas E, Xirouchakis E et al. Pitfalls in assessing renal function in patients with cirrhosis – potential inequity for access to treatment of hepatorenal failure and liver transplantation. Nephrol Dial Transplant 2011; 26(9): 2735–2742. doi: 10.1093/ndt/gfr354.
5. Wadei HM, Geiger XJ, Cortese C et al. Kidney allocation to liver transplant candidates with renal failure of undetermined etiology: role of percutaneous renal biopsy. Am J  Transplant 2008; 8(12): 2618–2626. doi: 10.1111/j.1600-6143.2008.02426.x.
6. Trunečka P. Hepatorenální poškození. In: Teplan V et al. Nefrologie vyššího věku. Praha: Mladá fronta 2015: 200–208.
7. Filip K. Ledviny a játra. In: Teplan V et al. Metabolismus a  ledviny. Praha: Grada Publishing 2000: 173–193.
8. Dube GK, Cohen DJ. Simultaneous liver and kidney transplantation. Curr Opin Nephrol Hypertens 2007; 16(6): 547–553. doi: 10.1097/ MNH.0b013e3282f1191e.
9. Teplan V et al. Akutní poškození a selhání ledvin v klinické medicíně. Praha: Grada 2009.
10. Schuck O, Teplan V, Mareckova O et al. Estimation of glomerular filtration rate based on the modification of diet in renal disease equation in patients with chronic renal failure. Kidney Blood Pressure Res 2005; 28(2): 63–67. doi: 10.1159/000083238.
11. Schück O. Examination of kidney function. Boston: Martinus Nijhoff Publisher 1984.
12. Schück O. Funkční vyšetření ledvin. In: Teplan V et al. Praktická nefrologie. Praha: Grada Publishing 2006: 38–44.
13. Schück O, Gottfriedova H, Malý J et al. Glomerular filtration rate assessment in individuals after orthotopic liver transplantation based on cystatin C levels. Liver Transpl 2002; 8(7): 594–599. doi: 10.1053/jlts.2002.33957.
14. Pipili C, Cholongitas E. Renal dysfunction in patients with cirhosis: where do we stand? World J Gastrointest Pharmacol Ther 2014; 5(3): 156–168. doi: 10.4292/wjgpt.v5.i3.156.
15. Beben T, Rifkin DE. GFR estimation equations and liver disease. Adv Chronic Kidney Dis 2015; 22(5): 337–342. doi: 10.1053/j.ackd.2015.05.003.
16. Krones E, Fickert P, Zitta s  et al. The chronic kidney disease epidemiology collaboration equation combining creatinine and cystatin C accurately assesses renal function in patients with cirhosis. BMC Nephrology 2015; 16: 196–206. doi: 10.1186/s12882-015-0188-0.
17. Krátká K, Libicherová P, Tesař V et al. Doporučené postupy ČNS a ČHS JEP pro diagnostiku a léčbu akutního poškození ledvin u jaterní cirhozy. Aktuality v nefrologii 2021; 27(1): 7–14.