Serum Kidney Injury Molecule-1 in Hepatorenal Syndrome at Medical Intensive Care Unit of Zagazig University Hospitals

Background Criteria of international club of ascites (IAC), 2007 for diagnosis of hepatorenal syndrome (HRS) did not rule out the possibility of renal parenchymal damage. Biomarkers of renal tubular damage especially kidney injury molecule-1 (KIM-1) has a potential role in differentiating types of acute kidney injury (AKI). Aim This study aimed at measuring serum KIM-1 in HRS patients to assess, sufficiency of IAC criteria 2007 to exclude intrinsic kidney injury, evaluate percentage of intrinsic kidney injury, and test the relation of serum KIM-1 to kidney functions in HRS patients. Methods 98 HRS patients according to IAC criteria (2007) admitted to medical ICU within 10 months were included and classified into type1 and type2 according to the level and rising pattern of serum creatinine. Complete blood picture, liver and kidney function tests, bleeding profile, arterial blood gases, pelvi-abdominal ultrasonography, and serum KIM-1 were evaluated. Results 73.5 % of HRS patients had type1 and 26.5 % had type2. The cutoff value of serum KIM-1 for severity of AKI in HRS is 3.69 ng/ml (88.6 % sensitivity, 76.9 % specificity and 0.81 % AUC). Percentage of intrinsic kidney injury was 76.1 % in type1 and 24.9 % in type2. There was significant positive correlation between serum KIM-1 and urine protein (r =0.45, P =0.005), serum creatinine (r =0.42, P =0.006) and Child-Pugh score and negative correlation with estimated glomerular filtration rate (r =-0.91, P =0.01). Conclusion Serum KIM-1 may be considered as a valid marker for prediction of intrinsic kidney injury among patients with HRS and classify them as type3.