Aguirre-Villarreal D, Leal-Villarreal MAJ, García-Juárez I, Argaiz ER, Koratala A. Sound waves and solutions: Point-of-care ultrasonography for acute kidney injury in cirrhosis. World J Crit Care Med 2024; 13(2): 91212 [PMID: 38855265 DOI: 10.5492/wjccm.v13.i2.91212]
Corresponding Author of This Article
Abhilash Koratala, MD, Associate Professor, Department of Nephrology, Medical College of Wisconsin, 8701 W Watertown Plank Road, Room A 7633, Milwaukee, WI 53226, United States. akoratala@mcw.edu
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Jun 9, 2024; 13(2): 91212 Published online Jun 9, 2024. doi: 10.5492/wjccm.v13.i2.91212
Sound waves and solutions: Point-of-care ultrasonography for acute kidney injury in cirrhosis
David Aguirre-Villarreal, Mario Andrés de Jesús Leal-Villarreal, Ignacio García-Juárez, Eduardo R Argaiz, Abhilash Koratala
David Aguirre-Villarreal, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
Mario Andrés de Jesús Leal-Villarreal, Cardiología, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
Ignacio García-Juárez, Unidad de Hepatología y Trasplante, Departamento de Gastroenterología, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City 14080, Mexico
Eduardo R Argaiz, Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
Eduardo R Argaiz, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City 64710, Mexico
Abhilash Koratala, Department of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
Author contributions: Aguirre-Villarreal D, Leal-Villarreal MAJ and Garcia-Juarez I drafted the initial version of the manuscript; Argaiz ER and Koratala A reviewed and revised the manuscript for critical intellectual content.
Supported by Research funding from KidneyCure and the American Society of Nephrology’s William and Sandra Bennett Clinical Scholars Grant (to Abhilash Koratala).
Conflict-of-interest statement: All authors report no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Abhilash Koratala, MD, Associate Professor, Department of Nephrology, Medical College of Wisconsin, 8701 W Watertown Plank Road, Room A 7633, Milwaukee, WI 53226, United States. akoratala@mcw.edu
Received: December 24, 2023 Revised: March 5, 2024 Accepted: April 22, 2024 Published online: June 9, 2024 Processing time: 161 Days and 15.2 Hours
Abstract
This article delves into the intricate challenges of acute kidney injury (AKI) in cirrhosis, a condition fraught with high morbidity and mortality. The complexities arise from distinguishing between various causes of AKI, particularly hemodynamic AKI, in cirrhotic patients, who experience hemodynamic changes due to portal hypertension. The term "hepatocardiorenal syndrome" is introduced to encapsulate the intricate interplay among the liver, heart, and kidneys. The narrative emphasizes the often-overlooked aspect of cardiac function in AKI assessments in cirrhosis, unveiling the prevalence of cirrhotic cardiomyopathy marked by impaired diastolic function. The conventional empiric approach involving volume expansion and vasopressors for hepatorenal syndrome is critically analyzed, highlighting potential risks and variable patient responses. We advocate for a nuanced algorithm for AKI evaluation in cirrhosis, prominently featuring point-of-care ultrasonography (POCUS). POCUS applications encompass assessing fluid tolerance, detecting venous congestion, and evaluating cardiac function.
Core Tip: In evaluating acute kidney injury in cirrhotic patients, point-of-care ultrasonography (POCUS) plays a pivotal role. This non-invasive diagnostic tool, when thoughtfully integrated, enhances sensitivity of physical examination, facilitates nuanced fluid management, and fine-tunes bedside hemodynamic evaluation. In the delicate interplay of liver, heart, and kidneys, POCUS emerges as an indispensable ally, refining assessments and steering towards optimal patient outcomes.
