Acute kidney injury in patients with cirrhosis: Perils and promise

Justin M. Belcher, Chirag R. Parikh, Guadalupe Garcia-Tsao

Research output: Contribution to journalArticlepeer-review

42 Scopus citations


A 62-year-old man with cirrhosis secondary to hepatitis C and chronic alcohol abuse was admitted to the intensive care unit with hematemesis and mental status changes. Physical examination showed ascites and stigmata of chronic liver disease. Blood pressure was noted as 87/42 mm Hg and laboratory studies showed a serum creatinine level of 0.8 mg/dL, an estimated glomerular filtration rate of 84 mL/min/1.73 m2 calculated using the Modification of Diet in Renal Disease Study equation, a serum sodium level of 123 mEq/L, a total serum bilirubin level of 4.3 mg/dL, and an international normalization ratio of 1.6. The patient was resuscitated with packed red blood cells and fresh-frozen plasma and bleeding was controlled. However, on the third day of admission, creatinine level increased to 1.5 mg/dL. Examination of urine sediment showed 1 to 5 bilirubin-stained granular casts per high-powered field and a few renal tubular epithelial cells. The urine sodium level was 21 mEq/L and the fractional excretion of sodium was 0.43%.

Original languageEnglish (US)
Pages (from-to)1550-1558
Number of pages9
JournalClinical Gastroenterology and Hepatology
Issue number12
StatePublished - Dec 2013
Externally publishedYes


  • Acute Tubular Necrosis
  • Ascites
  • Cirrhosis
  • Hepatorenal
  • Kidney Injury
  • Urinary Biomarkers

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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