Working Party proposal for a revised classification system of renal dysfunction in patients with cirrhosis
Identifieur interne : 002263 ( Istex/Corpus ); précédent : 002262; suivant : 002264Working Party proposal for a revised classification system of renal dysfunction in patients with cirrhosis
Auteurs : Florence Wong ; Mitra K. Nadim ; John A. Kellum ; Francesco Salerno ; Rinaldo Bellomo ; Alexander Gerbes ; Paolo Angeli ; Richard Moreau ; Andrew Davenport ; Rajiv Jalan ; Claudio Ronco ; Yuri Genyk ; Vicente ArroyoSource :
- Gut [ 0017-5749 ] ; 2011-05.
English descriptors
- KwdEn :
- Acute deterioration, Acute dialysis quality initiative, Acute kidney injury, Acute kidney injury network, Adqi, Ascites, Baseline, Cardiac, Cardiac output, Chronic kidney disease, Cirrhosis, Cirrhotic, Cirrhotic patients, Creatinine, Creatinine clearance, Decompensated cirrhosis, Diagnostic criteria, Dysfunction, Glomerular, Hepatology, Hepatorenal, Hepatorenal syndrome, Hyperdynamic circulation, Hypertension, Intensive care, International ascites club, Kidney, Kidney damage, Kidney disease, Kidney function, Liver cirrhosis, Liver disease, Ltration, Ltration rate, Mdrd6, Mdrd6 formula, Natural history, Nephropathy, Other forms, Pathophysiology, Portal hypertension, Refractory ascites, Renal, Renal blood, Renal disease, Renal dysfunction, Renal failure, Renal function, Renal impairment, Renal vasoconstriction, Rifle criteria, Serum creatinine, Southern california, Splanchnic, Summary statements, Syndrome, Systemic circulation, University college london, Urine, Wong.
- Teeft :
- Acute deterioration, Acute dialysis quality initiative, Acute kidney injury, Acute kidney injury network, Adqi, Ascites, Baseline, Cardiac, Cardiac output, Chronic kidney disease, Cirrhosis, Cirrhotic, Cirrhotic patients, Creatinine, Creatinine clearance, Decompensated cirrhosis, Diagnostic criteria, Dysfunction, Glomerular, Hepatology, Hepatorenal, Hepatorenal syndrome, Hyperdynamic circulation, Hypertension, Intensive care, International ascites club, Kidney, Kidney damage, Kidney disease, Kidney function, Liver cirrhosis, Liver disease, Ltration, Ltration rate, Mdrd6, Mdrd6 formula, Natural history, Nephropathy, Other forms, Pathophysiology, Portal hypertension, Refractory ascites, Renal, Renal blood, Renal disease, Renal dysfunction, Renal failure, Renal function, Renal impairment, Renal vasoconstriction, Rifle criteria, Serum creatinine, Southern california, Splanchnic, Summary statements, Syndrome, Systemic circulation, University college london, Urine, Wong.
Abstract
Objectives To propose an improvement on the current classification of renal dysfunction in cirrhosis. Clinicians caring for patients with cirrhosis recognize that the development of renal dysfunction is associated with significant morbidity and mortality. While most cases of renal dysfunction in cirrhosis are functional in nature, developed as a result of changes in haemodynamics, cardiac function, and renal auto-regulation, there is an increasing number of patients with cirrhosis and structural changes in their kidney as a cause of renal dysfunction. Therefore, there is a need for a newer classification to include both functional and structural renal diseases. Design A working party consisting of specialists from multiple disciplines conducted literature search and developed summary statements, incorporating the renal dysfunction classification used in nephrology. These were discussed and revised to produce this proposal. Setting Multi-disciplinary international meeting. Patients None. Interventions Literature search using keywords of cirrhosis, renal dysfunction, acute kidney injury (AKI), chronic kidney injury (CKD), and hepatorenal syndrome. Results Acute kidney injury will include all causes of acute deterioration of renal function as indicated by an increase in serum creatinine of >50% from baseline, or a rise in serum creatinine of ≥26.4µmol/L (≥0.3mg/dL) in <48hours. Chronic renal disease will be defined as an estimated glomerular filtration rate (GFR) of <60ml/min calculated using the Modification of Diet in Renal Disease 6 (MDRD6) formula, recognising that the MDRD6 formula is not perfect for the cirrhotic patients and this may change as improved means of estimating GFR becomes available. Acute on chronic kidney disease will be defined as AKI superimposed on existing chronic renal disease using the above definitions for AKI and CKD. Conclusions Accepting this new classification will allow studies into the epidemiology, incidence, prevalence, natural history and the development of new treatments for these subtypes of renal dysfunction in cirrhosis.
Url:
DOI: 10.1136/gut.2010.236133
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Nadim</name><affiliation><mods:affiliation>Division of Nephrology, University of Southern California, Los Angeles, California, USA</mods:affiliation></affiliation></author><author><name sortKey="Kellum, John A" sort="Kellum, John A" uniqKey="Kellum J" first="John A" last="Kellum">John A. Kellum</name><affiliation><mods:affiliation>Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, USA</mods:affiliation></affiliation></author><author><name sortKey="Salerno, Francesco" sort="Salerno, Francesco" uniqKey="Salerno F" first="Francesco" last="Salerno">Francesco Salerno</name><affiliation><mods:affiliation>Policlinico IRCCS San Donato and Dipartimento di Scienze Medico-Chirurgiche, Università di Milano, Milano, Italy</mods:affiliation></affiliation></author><author><name sortKey="Bellomo, Rinaldo" sort="Bellomo, Rinaldo" uniqKey="Bellomo R" first="Rinaldo" last="Bellomo">Rinaldo Bellomo</name><affiliation><mods:affiliation>Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia</mods:affiliation></affiliation></author><author><name sortKey="Gerbes, Alexander" sort="Gerbes, Alexander" uniqKey="Gerbes A" first="Alexander" last="Gerbes">Alexander Gerbes</name><affiliation><mods:affiliation>Liver Center Munich, Klinikum München-Grosshadern, Ludwig-Maximilians-Universität München, München, Germany</mods:affiliation></affiliation></author><author><name sortKey="Angeli, Paolo" sort="Angeli, Paolo" uniqKey="Angeli P" first="Paolo" last="Angeli">Paolo Angeli</name><affiliation><mods:affiliation>Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy</mods:affiliation></affiliation></author><author><name sortKey="Moreau, Richard" sort="Moreau, Richard" uniqKey="Moreau R" first="Richard" last="Moreau">Richard Moreau</name><affiliation><mods:affiliation>Centre de Recherche Biomédicale Bichat-Beaujon, Service d'Hépatologie, Hôpital Beaujon, Clichy, France</mods:affiliation></affiliation></author><author><name sortKey="Davenport, Andrew" sort="Davenport, Andrew" uniqKey="Davenport A" first="Andrew" last="Davenport">Andrew Davenport</name><affiliation><mods:affiliation>Centre for Nephrology, University College London Medical School, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Jalan, Rajiv" sort="Jalan, Rajiv" uniqKey="Jalan R" first="Rajiv" last="Jalan">Rajiv Jalan</name><affiliation><mods:affiliation>Institute of Hepatology, University College London Medical School, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Ronco, Claudio" sort="Ronco, Claudio" uniqKey="Ronco C" first="Claudio" last="Ronco">Claudio Ronco</name><affiliation><mods:affiliation>Division of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy</mods:affiliation></affiliation></author><author><name sortKey="Genyk, Yuri" sort="Genyk, Yuri" uniqKey="Genyk Y" first="Yuri" last="Genyk">Yuri Genyk</name><affiliation><mods:affiliation>Division of Multiorgan Abdominal Transplantation, University of Southern California, Los Angeles, California, USA</mods:affiliation></affiliation></author><author><name sortKey="Arroyo, Vicente" sort="Arroyo, Vicente" uniqKey="Arroyo V" first="Vicente" last="Arroyo">Vicente Arroyo</name><affiliation><mods:affiliation>Liver Unit, Institute of Digestive and Metabolic Diseases, Hospital Clinic, University of Barcelona, Spain</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Gut</title><title level="j" type="abbrev">Gut</title><idno type="ISSN">0017-5749</idno><idno type="eISSN">1468-3288</idno><imprint><publisher>BMJ Publishing Group Ltd and British Society of Gastroenterology</publisher><date type="published" when="2011-05">2011-05</date><biblScope unit="volume">60</biblScope><biblScope unit="issue">5</biblScope><biblScope unit="page" from="702">702</biblScope></imprint><idno type="ISSN">0017-5749</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0017-5749</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Acute deterioration</term><term>Acute dialysis quality initiative</term><term>Acute kidney injury</term><term>Acute kidney injury network</term><term>Adqi</term><term>Ascites</term><term>Baseline</term><term>Cardiac</term><term>Cardiac output</term><term>Chronic kidney disease</term><term>Cirrhosis</term><term>Cirrhotic</term><term>Cirrhotic patients</term><term>Creatinine</term><term>Creatinine clearance</term><term>Decompensated cirrhosis</term><term>Diagnostic criteria</term><term>Dysfunction</term><term>Glomerular</term><term>Hepatology</term><term>Hepatorenal</term><term>Hepatorenal syndrome</term><term>Hyperdynamic circulation</term><term>Hypertension</term><term>Intensive care</term><term>International ascites club</term><term>Kidney</term><term>Kidney damage</term><term>Kidney disease</term><term>Kidney function</term><term>Liver cirrhosis</term><term>Liver disease</term><term>Ltration</term><term>Ltration rate</term><term>Mdrd6</term><term>Mdrd6 formula</term><term>Natural history</term><term>Nephropathy</term><term>Other forms</term><term>Pathophysiology</term><term>Portal hypertension</term><term>Refractory ascites</term><term>Renal</term><term>Renal blood</term><term>Renal disease</term><term>Renal dysfunction</term><term>Renal failure</term><term>Renal function</term><term>Renal impairment</term><term>Renal vasoconstriction</term><term>Rifle criteria</term><term>Serum creatinine</term><term>Southern california</term><term>Splanchnic</term><term>Summary statements</term><term>Syndrome</term><term>Systemic circulation</term><term>University college london</term><term>Urine</term><term>Wong</term></keywords><keywords scheme="Teeft" xml:lang="en"><term>Acute deterioration</term><term>Acute dialysis quality initiative</term><term>Acute kidney injury</term><term>Acute kidney injury network</term><term>Adqi</term><term>Ascites</term><term>Baseline</term><term>Cardiac</term><term>Cardiac output</term><term>Chronic kidney disease</term><term>Cirrhosis</term><term>Cirrhotic</term><term>Cirrhotic patients</term><term>Creatinine</term><term>Creatinine clearance</term><term>Decompensated cirrhosis</term><term>Diagnostic criteria</term><term>Dysfunction</term><term>Glomerular</term><term>Hepatology</term><term>Hepatorenal</term><term>Hepatorenal syndrome</term><term>Hyperdynamic circulation</term><term>Hypertension</term><term>Intensive care</term><term>International ascites club</term><term>Kidney</term><term>Kidney damage</term><term>Kidney disease</term><term>Kidney function</term><term>Liver cirrhosis</term><term>Liver disease</term><term>Ltration</term><term>Ltration rate</term><term>Mdrd6</term><term>Mdrd6 formula</term><term>Natural history</term><term>Nephropathy</term><term>Other forms</term><term>Pathophysiology</term><term>Portal hypertension</term><term>Refractory ascites</term><term>Renal</term><term>Renal blood</term><term>Renal disease</term><term>Renal dysfunction</term><term>Renal failure</term><term>Renal function</term><term>Renal impairment</term><term>Renal vasoconstriction</term><term>Rifle criteria</term><term>Serum creatinine</term><term>Southern california</term><term>Splanchnic</term><term>Summary statements</term><term>Syndrome</term><term>Systemic circulation</term><term>University college london</term><term>Urine</term><term>Wong</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Objectives To propose an improvement on the current classification of renal dysfunction in cirrhosis. Clinicians caring for patients with cirrhosis recognize that the development of renal dysfunction is associated with significant morbidity and mortality. While most cases of renal dysfunction in cirrhosis are functional in nature, developed as a result of changes in haemodynamics, cardiac function, and renal auto-regulation, there is an increasing number of patients with cirrhosis and structural changes in their kidney as a cause of renal dysfunction. Therefore, there is a need for a newer classification to include both functional and structural renal diseases. Design A working party consisting of specialists from multiple disciplines conducted literature search and developed summary statements, incorporating the renal dysfunction classification used in nephrology. These were discussed and revised to produce this proposal. Setting Multi-disciplinary international meeting. Patients None. Interventions Literature search using keywords of cirrhosis, renal dysfunction, acute kidney injury (AKI), chronic kidney injury (CKD), and hepatorenal syndrome. Results Acute kidney injury will include all causes of acute deterioration of renal function as indicated by an increase in serum creatinine of >50% from baseline, or a rise in serum creatinine of ≥26.4µmol/L (≥0.3mg/dL) in <48hours. Chronic renal disease will be defined as an estimated glomerular filtration rate (GFR) of <60ml/min calculated using the Modification of Diet in Renal Disease 6 (MDRD6) formula, recognising that the MDRD6 formula is not perfect for the cirrhotic patients and this may change as improved means of estimating GFR becomes available. Acute on chronic kidney disease will be defined as AKI superimposed on existing chronic renal disease using the above definitions for AKI and CKD. Conclusions Accepting this new classification will allow studies into the epidemiology, incidence, prevalence, natural history and the development of new treatments for these subtypes of renal dysfunction in cirrhosis.</div></front></TEI><istex><corpusName>bmj</corpusName><keywords><teeft><json:string>cirrhosis</json:string><json:string>renal</json:string><json:string>creatinine</json:string><json:string>dysfunction</json:string><json:string>renal dysfunction</json:string><json:string>serum creatinine</json:string><json:string>hepatorenal</json:string><json:string>hepatorenal syndrome</json:string><json:string>renal function</json:string><json:string>ascites</json:string><json:string>cirrhotic</json:string><json:string>hepatology</json:string><json:string>acute kidney injury</json:string><json:string>diagnostic criteria</json:string><json:string>ltration</json:string><json:string>cirrhotic patients</json:string><json:string>ltration rate</json:string><json:string>renal failure</json:string><json:string>hypertension</json:string><json:string>pathophysiology</json:string><json:string>chronic kidney disease</json:string><json:string>liver disease</json:string><json:string>splanchnic</json:string><json:string>mdrd6</json:string><json:string>adqi</json:string><json:string>portal hypertension</json:string><json:string>renal blood</json:string><json:string>wong</json:string><json:string>nephropathy</json:string><json:string>syndrome</json:string><json:string>natural history</json:string><json:string>baseline</json:string><json:string>kidney</json:string><json:string>mdrd6 formula</json:string><json:string>acute deterioration</json:string><json:string>renal disease</json:string><json:string>kidney disease</json:string><json:string>refractory ascites</json:string><json:string>urine</json:string><json:string>university college london</json:string><json:string>cardiac output</json:string><json:string>rifle criteria</json:string><json:string>kidney function</json:string><json:string>kidney damage</json:string><json:string>other forms</json:string><json:string>southern california</json:string><json:string>cardiac</json:string><json:string>international ascites club</json:string><json:string>renal vasoconstriction</json:string><json:string>decompensated cirrhosis</json:string><json:string>liver cirrhosis</json:string><json:string>creatinine clearance</json:string><json:string>renal impairment</json:string><json:string>acute kidney injury network</json:string><json:string>acute dialysis quality initiative</json:string><json:string>intensive care</json:string><json:string>summary statements</json:string><json:string>hyperdynamic circulation</json:string><json:string>systemic circulation</json:string><json:string>glomerular</json:string></teeft></keywords><author><json:item><name>Florence Wong</name><affiliations><json:string>Department of Medicine, University of Toronto, Toronto, Canada</json:string><json:string>E-mail: florence.wong@utoronto.ca</json:string></affiliations></json:item><json:item><name>Mitra K Nadim</name><affiliations><json:string>Division of Nephrology, University of Southern California, Los Angeles, California, USA</json:string></affiliations></json:item><json:item><name>John A Kellum</name><affiliations><json:string>Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, USA</json:string></affiliations></json:item><json:item><name>Francesco Salerno</name><affiliations><json:string>Policlinico IRCCS San Donato and Dipartimento di Scienze Medico-Chirurgiche, Università di Milano, Milano, Italy</json:string></affiliations></json:item><json:item><name>Rinaldo Bellomo</name><affiliations><json:string>Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia</json:string></affiliations></json:item><json:item><name>Alexander Gerbes</name><affiliations><json:string>Liver Center Munich, Klinikum München-Grosshadern, Ludwig-Maximilians-Universität München, München, Germany</json:string></affiliations></json:item><json:item><name>Paolo Angeli</name><affiliations><json:string>Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy</json:string></affiliations></json:item><json:item><name>Richard Moreau</name><affiliations><json:string>Centre de Recherche Biomédicale Bichat-Beaujon, Service d'Hépatologie, Hôpital Beaujon, Clichy, France</json:string></affiliations></json:item><json:item><name>Andrew Davenport</name><affiliations><json:string>Centre for Nephrology, University College London Medical School, London, UK</json:string></affiliations></json:item><json:item><name>Rajiv Jalan</name><affiliations><json:string>Institute of Hepatology, University College London Medical School, London, UK</json:string></affiliations></json:item><json:item><name>Claudio Ronco</name><affiliations><json:string>Division of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy</json:string></affiliations></json:item><json:item><name>Yuri Genyk</name><affiliations><json:string>Division of Multiorgan Abdominal Transplantation, University of Southern California, Los Angeles, California, USA</json:string></affiliations></json:item><json:item><name>Vicente Arroyo</name><affiliations><json:string>Liver Unit, Institute of Digestive and Metabolic Diseases, Hospital Clinic, University of Barcelona, Spain</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Acute kidney injury</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>chronic kidney disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>cirrhosis</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>creatinine</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>hepatorenal syndrome</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>renal dysfunction</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>liver cirrhosis</value></json:item></subject><articleId><json:string>gutjnl236133</json:string></articleId><arkIstex>ark:/67375/NVC-GTWV3BBF-G</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>Objectives To propose an improvement on the current classification of renal dysfunction in cirrhosis. Clinicians caring for patients with cirrhosis recognize that the development of renal dysfunction is associated with significant morbidity and mortality. While most cases of renal dysfunction in cirrhosis are functional in nature, developed as a result of changes in haemodynamics, cardiac function, and renal auto-regulation, there is an increasing number of patients with cirrhosis and structural changes in their kidney as a cause of renal dysfunction. Therefore, there is a need for a newer classification to include both functional and structural renal diseases. Design A working party consisting of specialists from multiple disciplines conducted literature search and developed summary statements, incorporating the renal dysfunction classification used in nephrology. These were discussed and revised to produce this proposal. Setting Multi-disciplinary international meeting. Patients None. Interventions Literature search using keywords of cirrhosis, renal dysfunction, acute kidney injury (AKI), chronic kidney injury (CKD), and hepatorenal syndrome. Results Acute kidney injury will include all causes of acute deterioration of renal function as indicated by an increase in serum creatinine of >50% from baseline, or a rise in serum creatinine of ≥26.4µmol/L (≥0.3mg/dL) in >48hours. Chronic renal disease will be defined as an estimated glomerular filtration rate (GFR) of >60ml/min calculated using the Modification of Diet in Renal Disease 6 (MDRD6) formula, recognising that the MDRD6 formula is not perfect for the cirrhotic patients and this may change as improved means of estimating GFR becomes available. Acute on chronic kidney disease will be defined as AKI superimposed on existing chronic renal disease using the above definitions for AKI and CKD. Conclusions Accepting this new classification will allow studies into the epidemiology, incidence, prevalence, natural history and the development of new treatments for these subtypes of renal dysfunction in cirrhosis.</abstract><qualityIndicators><score>10</score><pdfWordCount>6128</pdfWordCount><pdfCharCount>40580</pdfCharCount><pdfVersion>1.4</pdfVersion><pdfPageCount>8</pdfPageCount><pdfPageSize>595.276 x 793.701 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractWordCount>298</abstractWordCount><abstractCharCount>2093</abstractCharCount><keywordCount>7</keywordCount></qualityIndicators><title>Working Party proposal for a revised classification system of renal dysfunction in patients with cirrhosis</title><pmid><json:string>21325171</json:string></pmid><genre><json:string>research-article</json:string></genre><host><title>Gut</title><language><json:string>unknown</json:string></language><issn><json:string>0017-5749</json:string></issn><eissn><json:string>1468-3288</json:string></eissn><publisherId><json:string>gut</json:string></publisherId><volume>60</volume><issue>5</issue><pages><first>702</first></pages><genre><json:string>journal</json:string></genre><subject><json:item><value>Editor's choice</value></json:item></subject></host><namedEntities><unitex><date><json:string>1979</json:string><json:string>2005</json:string><json:string>2011-02-15</json:string><json:string>1959</json:string><json:string>2010</json:string><json:string>2004</json:string><json:string>1996</json:string></date><geogName></geogName><orgName><json:string>Institute of Digestive and Metabolic Diseases</json:string><json:string>Working Party</json:string><json:string>Department of Clinical and Experimental Medicine</json:string><json:string>National Kidney Foundation</json:string><json:string>University of Padova</json:string><json:string>Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, USA</json:string><json:string>Division of Nephrology</json:string><json:string>Department of Medicine, Toronto General Hospital, University of Toronto</json:string><json:string>Department of Medicine, University of Toronto, Toronto, Canada</json:string><json:string>Hospital Clinic, University of Barcelona, Spain Correspondence</json:string><json:string>University of Southern California, Los Angeles</json:string><json:string>Modification of Diet in Renal Disease Study Group</json:string><json:string>Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia</json:string><json:string>Liver Center Munich</json:string><json:string>Division of Multiorgan Abdominal Transplantation</json:string><json:string>San Bortolo Hospital, Vicenza, Italy</json:string><json:string>Institute of Hepatology, University College London Medical School, London, UK</json:string><json:string>University of Southern California</json:string><json:string>FUTURE RESEARCH Future</json:string><json:string>Gambro Renal Care</json:string><json:string>Otsuka Pharmaceutical</json:string><json:string>Ikaria</json:string><json:string>IV League Inc</json:string><json:string>Baxter Inc</json:string><json:string>Nx-Stage Medical</json:string></orgName><orgName_funder><json:string>Gambro Renal Care</json:string><json:string>Otsuka Pharmaceutical</json:string><json:string>Ikaria</json:string><json:string>IV League Inc</json:string><json:string>Baxter Inc</json:string><json:string>Nx-Stage Medical</json:string></orgName_funder><orgName_provider></orgName_provider><persName><json:string>Paolo Angeli</json:string><json:string>Florence Wong</json:string><json:string>Rinaldo Bellomo</json:string><json:string>Claudio Ronco</json:string><json:string>Elizabeth Street</json:string><json:string>To</json:string><json:string>Group</json:string><json:string>Alexander Gerbes</json:string><json:string>Andrew Davenport</json:string><json:string>Vicente Arroyo</json:string><json:string>Richard Moreau</json:string><json:string>Yuri Genyk</json:string></persName><placeName><json:string>Germany</json:string><json:string>San Donato</json:string><json:string>UK</json:string><json:string>Canada</json:string><json:string>London</json:string><json:string>American</json:string><json:string>Toronto</json:string><json:string>France</json:string><json:string>Italy</json:string></placeName><ref_url></ref_url><ref_bibl><json:string>Papper et al</json:string><json:string>Epstein et al</json:string><json:string>Rodes et al</json:string></ref_bibl><bibl></bibl></unitex></namedEntities><ark><json:string>ark:/67375/NVC-GTWV3BBF-G</json:string></ark><categories><wos><json:string>1 - science</json:string><json:string>2 - gastroenterology & hepatology</json:string></wos><scienceMetrix><json:string>1 - health sciences</json:string><json:string>2 - clinical medicine</json:string><json:string>3 - gastroenterology & hepatology</json:string></scienceMetrix><scopus><json:string>1 - Health Sciences</json:string><json:string>2 - Medicine</json:string><json:string>3 - Gastroenterology</json:string></scopus><inist><json:string>1 - sciences appliquees, technologies et medecines</json:string><json:string>2 - sciences biologiques et medicales</json:string><json:string>3 - sciences medicales</json:string></inist></categories><publicationDate>2011</publicationDate><copyrightDate>2011</copyrightDate><doi><json:string>10.1136/gut.2010.236133</json:string></doi><id>B8FB2AF0C0A4DB8C9B25369EB3919E64CEA3683C</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/B8FB2AF0C0A4DB8C9B25369EB3919E64CEA3683C/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/B8FB2AF0C0A4DB8C9B25369EB3919E64CEA3683C/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/B8FB2AF0C0A4DB8C9B25369EB3919E64CEA3683C/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">Working Party proposal for a revised classification system of renal dysfunction in patients with cirrhosis</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher scheme="https://publisher-list.data.istex.fr">BMJ Publishing Group Ltd and British Society of Gastroenterology</publisher><availability><licence><p>© 2011, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</p></licence><p scheme="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-7M42M2QJ-2">bmj</p></availability><date>2011-02-15</date></publicationStmt><notesStmt><note type="research-article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</note><note type="journal" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Working Party proposal for a revised classification system of renal dysfunction in patients with cirrhosis</title><author xml:id="author-0000" corresp="yes"><persName><forename type="first">Florence</forename><surname>Wong</surname></persName><email>florence.wong@utoronto.ca</email><affiliation>Department of Medicine, University of Toronto, Toronto, Canada</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Mitra K</forename><surname>Nadim</surname></persName><affiliation>Division of Nephrology, University of Southern California, Los Angeles, California, USA</affiliation></author><author xml:id="author-0002"><persName><forename type="first">John A</forename><surname>Kellum</surname></persName><affiliation>Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, USA</affiliation></author><author xml:id="author-0003"><persName><forename type="first">Francesco</forename><surname>Salerno</surname></persName><affiliation>Policlinico IRCCS San Donato and Dipartimento di Scienze Medico-Chirurgiche, Università di Milano, Milano, Italy</affiliation></author><author xml:id="author-0004"><persName><forename type="first">Rinaldo</forename><surname>Bellomo</surname></persName><affiliation>Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia</affiliation></author><author xml:id="author-0005"><persName><forename type="first">Alexander</forename><surname>Gerbes</surname></persName><affiliation>Liver Center Munich, Klinikum München-Grosshadern, Ludwig-Maximilians-Universität München, München, Germany</affiliation></author><author xml:id="author-0006"><persName><forename type="first">Paolo</forename><surname>Angeli</surname></persName><affiliation>Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy</affiliation></author><author xml:id="author-0007"><persName><forename type="first">Richard</forename><surname>Moreau</surname></persName><affiliation>Centre de Recherche Biomédicale Bichat-Beaujon, Service d'Hépatologie, Hôpital Beaujon, Clichy, France</affiliation></author><author xml:id="author-0008"><persName><forename type="first">Andrew</forename><surname>Davenport</surname></persName><affiliation>Centre for Nephrology, University College London Medical School, London, UK</affiliation></author><author xml:id="author-0009"><persName><forename type="first">Rajiv</forename><surname>Jalan</surname></persName><affiliation>Institute of Hepatology, University College London Medical School, London, UK</affiliation></author><author xml:id="author-0010"><persName><forename type="first">Claudio</forename><surname>Ronco</surname></persName><affiliation>Division of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy</affiliation></author><author xml:id="author-0011"><persName><forename type="first">Yuri</forename><surname>Genyk</surname></persName><affiliation>Division of Multiorgan Abdominal Transplantation, University of Southern California, Los Angeles, California, USA</affiliation></author><author xml:id="author-0012"><persName><forename type="first">Vicente</forename><surname>Arroyo</surname></persName><affiliation>Liver Unit, Institute of Digestive and Metabolic Diseases, Hospital Clinic, University of Barcelona, Spain</affiliation></author><idno type="istex">B8FB2AF0C0A4DB8C9B25369EB3919E64CEA3683C</idno><idno type="ark">ark:/67375/NVC-GTWV3BBF-G</idno><idno type="DOI">10.1136/gut.2010.236133</idno><idno type="href">gutjnl-60-702.pdf</idno><idno type="article-id">gutjnl236133</idno><idno type="PMID">21325171</idno><idno type="local">gutjnl;60/5/702</idno></analytic><monogr><title level="j">Gut</title><title level="j" type="abbrev">Gut</title><idno type="pISSN">0017-5749</idno><idno type="eISSN">1468-3288</idno><idno type="publisher-id">gut</idno><idno type="PublisherID-hwp">gutjnl</idno><idno type="PublisherID-nlm-ta">Gut</idno><imprint><publisher>BMJ Publishing Group Ltd and British Society of Gastroenterology</publisher><date type="published" when="2011-05"></date><biblScope unit="volume">60</biblScope><biblScope unit="issue">5</biblScope><biblScope unit="page" from="702">702</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2011-02-15</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Objectives To propose an improvement on the current classification of renal dysfunction in cirrhosis. Clinicians caring for patients with cirrhosis recognize that the development of renal dysfunction is associated with significant morbidity and mortality. While most cases of renal dysfunction in cirrhosis are functional in nature, developed as a result of changes in haemodynamics, cardiac function, and renal auto-regulation, there is an increasing number of patients with cirrhosis and structural changes in their kidney as a cause of renal dysfunction. Therefore, there is a need for a newer classification to include both functional and structural renal diseases. Design A working party consisting of specialists from multiple disciplines conducted literature search and developed summary statements, incorporating the renal dysfunction classification used in nephrology. These were discussed and revised to produce this proposal. Setting Multi-disciplinary international meeting. Patients None. Interventions Literature search using keywords of cirrhosis, renal dysfunction, acute kidney injury (AKI), chronic kidney injury (CKD), and hepatorenal syndrome. Results Acute kidney injury will include all causes of acute deterioration of renal function as indicated by an increase in serum creatinine of >50% from baseline, or a rise in serum creatinine of ≥26.4µmol/L (≥0.3mg/dL) in <48hours. Chronic renal disease will be defined as an estimated glomerular filtration rate (GFR) of <60ml/min calculated using the Modification of Diet in Renal Disease 6 (MDRD6) formula, recognising that the MDRD6 formula is not perfect for the cirrhotic patients and this may change as improved means of estimating GFR becomes available. Acute on chronic kidney disease will be defined as AKI superimposed on existing chronic renal disease using the above definitions for AKI and CKD. Conclusions Accepting this new classification will allow studies into the epidemiology, incidence, prevalence, natural history and the development of new treatments for these subtypes of renal dysfunction in cirrhosis.</p></abstract><textClass><keywords scheme="keyword"><list><head>keywords</head><item><term>Acute kidney injury</term></item><item><term>chronic kidney disease</term></item><item><term>cirrhosis</term></item><item><term>creatinine</term></item><item><term>hepatorenal syndrome</term></item><item><term>renal dysfunction</term></item><item><term>liver cirrhosis</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Editor's choice</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2011-02-15">Created</change><change when="2011-05">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/B8FB2AF0C0A4DB8C9B25369EB3919E64CEA3683C/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">gutjnl</journal-id><journal-id journal-id-type="nlm-ta">Gut</journal-id><journal-id journal-id-type="publisher-id">gut</journal-id><journal-title>Gut</journal-title><abbrev-journal-title abbrev-type="publisher">Gut</abbrev-journal-title><abbrev-journal-title>Gut</abbrev-journal-title><issn pub-type="ppub">0017-5749</issn><issn pub-type="epub">1468-3288</issn><publisher><publisher-name>BMJ Publishing Group Ltd and British Society of Gastroenterology</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">gutjnl236133</article-id><article-id pub-id-type="doi">10.1136/gut.2010.236133</article-id><article-id pub-id-type="other">gutjnl;60/5/702</article-id><article-id pub-id-type="other">gutjnl;gut.2010.236133</article-id><article-id pub-id-type="pmid">21325171</article-id><article-id pub-id-type="other">702</article-id><article-id pub-id-type="other">gut.2010.236133</article-id><article-categories><subj-group subj-group-type="heading"><subject>Hepatology</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Editor's choice</subject></subj-group></article-categories><title-group><article-title>Working Party proposal for a revised classification system of renal dysfunction in patients with cirrhosis</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Wong</surname><given-names>Florence</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Nadim</surname><given-names>Mitra K</given-names></name><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Kellum</surname><given-names>John A</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Salerno</surname><given-names>Francesco</given-names></name><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Bellomo</surname><given-names>Rinaldo</given-names></name><xref ref-type="aff" rid="aff5">5</xref></contrib><contrib contrib-type="author"><name><surname>Gerbes</surname><given-names>Alexander</given-names></name><xref ref-type="aff" rid="aff6">6</xref></contrib><contrib contrib-type="author"><name><surname>Angeli</surname><given-names>Paolo</given-names></name><xref ref-type="aff" rid="aff7">7</xref></contrib><contrib contrib-type="author"><name><surname>Moreau</surname><given-names>Richard</given-names></name><xref ref-type="aff" rid="aff8">8</xref></contrib><contrib contrib-type="author"><name><surname>Davenport</surname><given-names>Andrew</given-names></name><xref ref-type="aff" rid="aff9">9</xref></contrib><contrib contrib-type="author"><name><surname>Jalan</surname><given-names>Rajiv</given-names></name><xref ref-type="aff" rid="aff10">10</xref></contrib><contrib contrib-type="author"><name><surname>Ronco</surname><given-names>Claudio</given-names></name><xref ref-type="aff" rid="aff11">11</xref></contrib><contrib contrib-type="author"><name><surname>Genyk</surname><given-names>Yuri</given-names></name><xref ref-type="aff" rid="aff12">12</xref></contrib><contrib contrib-type="author"><name><surname>Arroyo</surname><given-names>Vicente</given-names></name><xref ref-type="aff" rid="aff13">13</xref></contrib></contrib-group><aff id="aff1"><label>1</label>Department of Medicine, University of Toronto, Toronto, Canada</aff><aff id="aff2"><label>2</label>Division of Nephrology, University of Southern California, Los Angeles, California, USA</aff><aff id="aff3"><label>3</label>Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, USA</aff><aff id="aff4"><label>4</label>Policlinico IRCCS San Donato and Dipartimento di Scienze Medico-Chirurgiche, Università di Milano, Milano, Italy</aff><aff id="aff5"><label>5</label>Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia</aff><aff id="aff6"><label>6</label>Liver Center Munich, Klinikum München-Grosshadern, Ludwig-Maximilians-Universität München, München, Germany</aff><aff id="aff7"><label>7</label>Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy</aff><aff id="aff8"><label>8</label>Centre de Recherche Biomédicale Bichat-Beaujon, Service d'Hépatologie, Hôpital Beaujon, Clichy, France</aff><aff id="aff9"><label>9</label>Centre for Nephrology, University College London Medical School, London, UK</aff><aff id="aff10"><label>10</label>Institute of Hepatology, University College London Medical School, London, UK</aff><aff id="aff11"><label>11</label>Division of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy</aff><aff id="aff12"><label>12</label>Division of Multiorgan Abdominal Transplantation, University of Southern California, Los Angeles, California, USA</aff><aff id="aff13"><label>13</label>Liver Unit, Institute of Digestive and Metabolic Diseases, Hospital Clinic, University of Barcelona, Spain</aff><author-notes><corresp><label>Correspondence to</label> Florence Wong, 9N/983, Department of Medicine, Toronto General Hospital, University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G2C4, Canada; <email>florence.wong@utoronto.ca</email></corresp></author-notes><pub-date pub-type="epub-original"><day>15</day><month>2</month><year>2011</year></pub-date><pub-date pub-type="ppub"><month>5</month><year>2011</year></pub-date><pub-date pub-type="epub"><day>15</day><month>2</month><year>2011</year></pub-date><volume>60</volume><volume-id pub-id-type="other">60</volume-id><volume-id pub-id-type="other">60</volume-id><issue>5</issue><issue-id pub-id-type="other">gutjnl;60/5</issue-id><issue-id pub-id-type="other">5</issue-id><issue-id pub-id-type="other">60/5</issue-id><fpage>702</fpage><history><date date-type="rev-recd"><day>22</day><month>1</month><year>2011</year></date><date date-type="accepted"><day>24</day><month>1</month><year>2011</year></date></history><permissions><copyright-statement>© 2011, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</copyright-statement><copyright-year>2011</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="gutjnl-60-702.pdf"></self-uri><abstract><sec><title>Objectives</title><p>To propose an improvement on the current classification of renal dysfunction in cirrhosis. Clinicians caring for patients with cirrhosis recognize that the development of renal dysfunction is associated with significant morbidity and mortality. While most cases of renal dysfunction in cirrhosis are functional in nature, developed as a result of changes in haemodynamics, cardiac function, and renal auto-regulation, there is an increasing number of patients with cirrhosis and structural changes in their kidney as a cause of renal dysfunction. Therefore, there is a need for a newer classification to include both functional and structural renal diseases.</p></sec><sec><title>Design</title><p>A working party consisting of specialists from multiple disciplines conducted literature search and developed summary statements, incorporating the renal dysfunction classification used in nephrology. These were discussed and revised to produce this proposal.</p></sec><sec><title>Setting</title><p>Multi-disciplinary international meeting.</p></sec><sec><title>Patients</title><p>None.</p></sec><sec><title>Interventions</title><p>Literature search using keywords of cirrhosis, renal dysfunction, acute kidney injury (AKI), chronic kidney injury (CKD), and hepatorenal syndrome.</p></sec><sec><title>Results</title><p>Acute kidney injury will include all causes of acute deterioration of renal function as indicated by an increase in serum creatinine of >50% from baseline, or a rise in serum creatinine of ≥26.4µmol/L (≥0.3mg/dL) in <48hours. Chronic renal disease will be defined as an estimated glomerular filtration rate (GFR) of <60ml/min calculated using the Modification of Diet in Renal Disease 6 (MDRD6) formula, recognising that the MDRD6 formula is not perfect for the cirrhotic patients and this may change as improved means of estimating GFR becomes available. Acute on chronic kidney disease will be defined as AKI superimposed on existing chronic renal disease using the above definitions for AKI and CKD.</p></sec><sec><title>Conclusions</title><p>Accepting this new classification will allow studies into the epidemiology, incidence, prevalence, natural history and the development of new treatments for these subtypes of renal dysfunction in cirrhosis.</p></sec></abstract><kwd-group><kwd>Acute kidney injury</kwd><kwd>chronic kidney disease</kwd><kwd>cirrhosis</kwd><kwd>creatinine</kwd><kwd>hepatorenal syndrome</kwd><kwd>renal dysfunction</kwd><kwd>liver cirrhosis</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Working Party proposal for a revised classification system of renal dysfunction in patients with cirrhosis</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Working Party proposal for a revised classification system of renal dysfunction in patients with cirrhosis</title></titleInfo><name type="personal" displayLabel="corresp"><namePart type="given">Florence</namePart><namePart type="family">Wong</namePart><affiliation>Department of Medicine, University of Toronto, Toronto, Canada</affiliation><affiliation>E-mail: florence.wong@utoronto.ca</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Mitra K</namePart><namePart type="family">Nadim</namePart><affiliation>Division of Nephrology, University of Southern California, Los Angeles, California, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">John A</namePart><namePart type="family">Kellum</namePart><affiliation>Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Francesco</namePart><namePart type="family">Salerno</namePart><affiliation>Policlinico IRCCS San Donato and Dipartimento di Scienze Medico-Chirurgiche, Università di Milano, Milano, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Rinaldo</namePart><namePart type="family">Bellomo</namePart><affiliation>Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Alexander</namePart><namePart type="family">Gerbes</namePart><affiliation>Liver Center Munich, Klinikum München-Grosshadern, Ludwig-Maximilians-Universität München, München, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Paolo</namePart><namePart type="family">Angeli</namePart><affiliation>Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Richard</namePart><namePart type="family">Moreau</namePart><affiliation>Centre de Recherche Biomédicale Bichat-Beaujon, Service d'Hépatologie, Hôpital Beaujon, Clichy, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Andrew</namePart><namePart type="family">Davenport</namePart><affiliation>Centre for Nephrology, University College London Medical School, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Rajiv</namePart><namePart type="family">Jalan</namePart><affiliation>Institute of Hepatology, University College London Medical School, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Claudio</namePart><namePart type="family">Ronco</namePart><affiliation>Division of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Yuri</namePart><namePart type="family">Genyk</namePart><affiliation>Division of Multiorgan Abdominal Transplantation, University of Southern California, Los Angeles, California, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Vicente</namePart><namePart type="family">Arroyo</namePart><affiliation>Liver Unit, Institute of Digestive and Metabolic Diseases, Hospital Clinic, University of Barcelona, Spain</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>BMJ Publishing Group Ltd and British Society of Gastroenterology</publisher><dateIssued encoding="w3cdtf">2011-05</dateIssued><dateCreated encoding="w3cdtf">2011-02-15</dateCreated><copyrightDate encoding="w3cdtf">2011</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><abstract>Objectives To propose an improvement on the current classification of renal dysfunction in cirrhosis. Clinicians caring for patients with cirrhosis recognize that the development of renal dysfunction is associated with significant morbidity and mortality. While most cases of renal dysfunction in cirrhosis are functional in nature, developed as a result of changes in haemodynamics, cardiac function, and renal auto-regulation, there is an increasing number of patients with cirrhosis and structural changes in their kidney as a cause of renal dysfunction. Therefore, there is a need for a newer classification to include both functional and structural renal diseases. Design A working party consisting of specialists from multiple disciplines conducted literature search and developed summary statements, incorporating the renal dysfunction classification used in nephrology. These were discussed and revised to produce this proposal. Setting Multi-disciplinary international meeting. Patients None. Interventions Literature search using keywords of cirrhosis, renal dysfunction, acute kidney injury (AKI), chronic kidney injury (CKD), and hepatorenal syndrome. Results Acute kidney injury will include all causes of acute deterioration of renal function as indicated by an increase in serum creatinine of >50% from baseline, or a rise in serum creatinine of ≥26.4µmol/L (≥0.3mg/dL) in <48hours. Chronic renal disease will be defined as an estimated glomerular filtration rate (GFR) of <60ml/min calculated using the Modification of Diet in Renal Disease 6 (MDRD6) formula, recognising that the MDRD6 formula is not perfect for the cirrhotic patients and this may change as improved means of estimating GFR becomes available. Acute on chronic kidney disease will be defined as AKI superimposed on existing chronic renal disease using the above definitions for AKI and CKD. Conclusions Accepting this new classification will allow studies into the epidemiology, incidence, prevalence, natural history and the development of new treatments for these subtypes of renal dysfunction in cirrhosis.</abstract><subject><genre>keywords</genre><topic>Acute kidney injury</topic><topic>chronic kidney disease</topic><topic>cirrhosis</topic><topic>creatinine</topic><topic>hepatorenal syndrome</topic><topic>renal dysfunction</topic><topic>liver cirrhosis</topic></subject><relatedItem type="host"><titleInfo><title>Gut</title></titleInfo><titleInfo type="abbreviated"><title>Gut</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><subject><genre>hwp-journal-coll</genre><topic>Editor's choice</topic></subject><identifier type="ISSN">0017-5749</identifier><identifier type="eISSN">1468-3288</identifier><identifier type="PublisherID">gut</identifier><identifier type="PublisherID-hwp">gutjnl</identifier><identifier type="PublisherID-nlm-ta">Gut</identifier><part><date>2011</date><detail type="volume"><caption>vol.</caption><number>60</number></detail><detail type="issue"><caption>no.</caption><number>5</number></detail><extent unit="pages"><start>702</start></extent></part></relatedItem><identifier type="istex">B8FB2AF0C0A4DB8C9B25369EB3919E64CEA3683C</identifier><identifier type="ark">ark:/67375/NVC-GTWV3BBF-G</identifier><identifier type="DOI">10.1136/gut.2010.236133</identifier><identifier type="href">gutjnl-60-702.pdf</identifier><identifier type="ArticleID">gutjnl236133</identifier><identifier type="PMID">21325171</identifier><identifier type="local">gutjnl;60/5/702</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2011, Published by the BMJ Publishing Group Limited. 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