The use of Nuetrophil Gelatinase Associated Lipocalin (NGAL) as a novel marker in early diagnosis of Hepato Renal Syndrome in advanced cirrhotic patients

Abstract

Acute kidney injury (AKI) in cirrhosis, including hepatorenal syndrome (HRS), is a common and serious complication in cirrhotic patients, leading to significant morbidity and mortality. HRS now is described as a more homogeneous condition with specific diagnostic features Historically, it was classified into 2 types: type 1 HRS, which was defined as rapid deterioration in kidney function over the course of 2 weeks with a serum creatinine level greater than 2.5 mg/dL, and type 2 HRS, which was characterized by a progressive slower course of moderate renal failure and serum creatinine concentrations between 1.5 and 2.5 mg/dL. According to the newer definition, HRS AKI now is defined as worsening kidney function in patients with advanced cirrhosis that meets the ICA-AKI criteria; failing to respond to volume expansion with albumin; the absence of recent exposure to nephrotoxic agents (such as aminoglycosides, nonsteroidal anti-inflammatories, or contrast media); and no evidence of shock or signs of structural kidney disease (defined as proteinuria <500 mg/d, hematuria <50 red blood cells per high-power field, and normal renal ultrasonographic findings).