Recent advances in pathophysiology, diagnosis and management of hepatorenal syndrome: A review

Table 2 Methods of estimating glomerular filtration rate and the novel biomarkers for diagnosis of acute kidney injury in cirrhosis

Ref.	Biomarker	Year Published-Patient population	Advantage(s)	Limitation(s)
Fagundes et al[102]	NGAL and/or IL-18	2012-Cirrhosis	Best supporting data; can differentiate HRS-AKI and ATN; predicts AKI progression; predicts mortality; NGAL has good performance in patients with ACLF	Increased in inflammation and infections (UTI); lack of standard cut-offs
Verna et al[103]		2012-Cirrhosis
Tsai et al[104]		2013-Cirrhosis
Gungor et al[105]		2014-Cirrhosis
Belcher et al[55]		2014-Cirrhosis
Barreto et al[106]		2014-Cirrhosis
Qasem et al[56]		2014-Cirrhosis
Treeprasertsuk et al[107]		2015-Cirrhosis
Ariza et al[57]		2015-Cirrhosis
Markwardt et al[59]	Cystatin C	2017-Cirrhosis	Predicts AKI progression; predicts short-term mortality; Used in combination with MELD score (MELD-cystatin score)	Increases in CKD
Maiwall et al[60]		2017-Cirrhosis
Jaques et al[108]		2019-Cirrhosis
Belcher et al[55]	KIM-1	2014-Cirrhosis	Predicts AKI progression; Predicts short-term mortality	Low sensitivity and specificity for differentiating causes of AKI
Ariza et al[57]		2015-Cirrhosis
Belcher et al[55]	L-FABP	2014-Cirhrosis	Predicts AKI progression; predicts short-term mortality	Increased in CKD; poor performance in differentiating causes of AKI
Jiang et al[109]		2018-Cirrhosis
Belcher et al[55]	Albumin	2014-Cirrhosis	Can differentiate HRS-AKI and ATN; good performance in ACLF; predicts short-term mortality; readily available	Decreased level in advanced cirrhosis

ACLF: Acute on chronic liver failure; AKI: Acute kidney injury; ATN: Acute tubular necrosis; CKD: Chronic kidney disease; HRS-AKI: Hepatorenal syndrome with acute kidney injury; IL-18: Interleukin 18; KIM-1: Kidney injury molecule 1; L-FABP: Liver-type fatty acid-binding protein; MELD: Model for end-stage liver disease; NGAL: Neutrophil gelatinase-associated lipocalin; SCr: Serum creatinine; UTI: Urinary tract infection.