ArticleWorld journal of nephrology2026
Integrated biomarkers and renal Doppler for early acute kidney injury diagnosis in hepatitis C virus cirrhosis.
Article in World journal of nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAcute kidney injury (AKI) complicates up to 65% of hospitalizations for decompensated cirrhosis and is associated with high short-term mortality. Traditional markers such as serum creatinine are unreliable in cirrhosis, while novel biomarkers like neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, and Doppler renal resistive index (RRI) show promise but have not been systematically validated in hepatitis C virus-endemic, resource-limited settings such as Egypt.
aimTo evaluate the diagnostic and prognostic utility of NGAL, cystatin C, and RRI for early AKI detection, subtyping [pre-renal, hepatorenal syndrome (HRS), acute tubular necrosis (ATN)], and mortality risk stratification in cirrhotic patients.
methodsIn this prospective cohort study, 120 cirrhotic patients with ascites were enrolled and categorized into three groups: Non-AKI (
resultsAKI was present in 65% (78/120) of patients. Of these, 52 (66.7%) had AKI at admission, and 26 (33.3%) developed AKI during hospitalization. NGAL distinguished AKI with area under the curve (AUC) of 0.91 (95%CI: 0.87-0.95) [cutoff > 150 ng/mL, sensitivity of 90% (85%-94%), specificity of 85% (78%-90%)]. RRI > 0.74 identified HRS with AUC of 0.89 (95%CI: 0.83-0.94) with sensitivity of 82%, specificity of 88%. Cystatin C showed moderate diagnostic value [AUC of 0.86 (95%CI: 0.81-0.91)]. Urinary granular casts were specific for ATN (100%), while renin and aldosterone levels were highest in HRS. NGAL > 150 ng/mL was independently associated with higher 30-day mortality (hazard ratio = 3.1, 95%CI: 1.7-5.5), while RRI > 0.74 was associated with poor renal recovery (hazard ratio = 2.2,
conclusionNGAL and RRI outperform creatinine in early AKI detection, subtyping, and prognostication in cirrhotic patients, while cystatin C adds diagnostic value, particularly in ambiguous cases. An NGAL-RRI-based algorithm, enhanced by cystatin C when needed, represents a practical, resource-efficient tool for AKI triage in resource-limited settings.
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