Interest of the Echocardiography in the Management of Cirrhotic Patients With Acute Kidney Injury

Interest of the Echocardiography in the Management of Cirrhotic Patients With Acute Kidney Injury

This prospective study focuses on the interest of the echocardiography for cirrhotic patients, who present acute kidney injury corresponding to the criteria of hepatorenal syndrome. This echocardiography will be done before the volemic expansion and the final diagnostic of hepatorenal syndrome or prerenal azotemia. The primary endpoint is to describe the hemodynamic characteristics of this population at the time of acute kidney injury and their association with diagnostic of hepatorenal syndrome or prerenal azotemia. Patients with elevated filling pressure, predicting poor outcome of volemic expansion will be excluded of the study after the echocardiography and will not undergo volemic expansion but appropriate management.

Inclusion Criteria:

• patients > 18 years
• written consent for the participation of the study
• cirrhosis with portal hypertension and ascite
• acute kidney injury according to AKIN criteria (rapid increase of creatinine (48 hours) > 26.4 µmol or > 50% comparing with baseline). Baseline creatinine is the last value of creatinine before admission or creatinine at the admission if stable during 5 days.
• absence of argument for acute tubular necrosis or other organic acute renal injury
• absence of argument for shock

Exclusion Criteria:

• pregnant women
• volemic expansion before echocardiography
• portal thrombosis
• presence of TIPSS
• history of cardiac or renal pathology
• atrial fibrillation
• cardiac valvulopathy
• technical limitation due to echogenicity