{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T20:17:34Z","timestamp":1778271454881,"version":"3.51.4"},"reference-count":21,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Acute kidney injury (AKI) is a common and serious complication in patients with liver cirrhosis and is associated with poor outcomes. However, whether the association between nephrotic-range proteinuria (NRP) and severe AKI varies by liver disease severity remains unclear. Methods: This retrospective cohort study included 408 adult patients with cirrhosis stratified by Child\u2013Pugh class (A, B, and C). Severe AKI was defined as Kidney Disease: Improving Global Outcomes stage 2\u20133. Multivariable logistic regression analyses were performed in the overall cohort and within each class, with the additional evaluation of interaction effects. Results: The incidence of severe AKI increased from 18.4% in class A to 38.8% in class C. In the extended multivariable model incorporating hemodynamic and inflammatory variables, nephrotic-range proteinuria was not significantly associated with severe AKI. In stratified analyses, a significant association was observed only in Child\u2013Pugh class A. Additional analyses suggested that this relationship was attenuated after accounting for sepsis and systemic severity. Conclusions: Although NRP prevalence was similar across Child\u2013Pugh classes, the association between NRP and severe AKI appeared to vary by disease stage, particularly before adjustment for systemic severity.<\/jats:p>","DOI":"10.3390\/jcm15103602","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T19:10:52Z","timestamp":1778267452000},"page":"3602","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Disease Stage-Dependent Association Between Nephrotic-Range Proteinuria and Severe Acute Kidney Injury in Patients with Liver Cirrhosis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7756-2632","authenticated-orcid":false,"given":"Gi Jeong","family":"Park","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Daegu Catholic University School of Medicine, Daegu 42472, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7900-7560","authenticated-orcid":false,"given":"Seong Gyu","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu 42472, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0398-5514","authenticated-orcid":false,"given":"Sang Gyu","family":"Kwak","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, Daegu Catholic University School of Medicine, Daegu 42472, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Attieh, R.M., and Wadei, H.M. (2023). Acute Kidney Injury in Liver Cirrhosis. Diagnostics, 13.","DOI":"10.3390\/diagnostics13142361"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Lungu, A., Sarbu, G.E., Cotlet, A.S., Savin, I.A., Damian, I.R., Juncu, S., Muzica, C., Girleanu, I., S\u00eengeap, A.M., and Stanciu, C. (2025). Acute Kidney Injury in Patients with Liver Cirrhosis: From Past to Present Definition and Diagnosis. Life, 15.","DOI":"10.3390\/life15081249"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"195","DOI":"10.14218\/JCTH.2015.00015","article-title":"Acute Kidney Injury in Patients with Cirrhosis","volume":"3","author":"Russ","year":"2015","journal-title":"J. Clin. Transl. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1080\/17474124.2024.2380299","article-title":"Incidence and risk factors of acute kidney injury in cirrhosis: A systematic review and meta-analysis of 5,202,232 outpatients, inpatients, and ICU-admitted patients","volume":"18","author":"Lekakis","year":"2024","journal-title":"Expert. Rev. Gastroenterol. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1817","DOI":"10.1007\/s11845-024-03663-z","article-title":"Study of prevalence, risk factors for acute kidney injury, and mortality in liver cirrhosis patients","volume":"193","author":"Mohan","year":"2024","journal-title":"Ir. J. Med. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Abboud, Y., Rajan, A., Rosenblatt, R.E., Tow, C., Jesudian, A., Fortune, B.E., and Hajifathalian, K. (2024). Predictors of Acute Kidney Injury Resolution and Associated Clinical Outcomes Among Hospitalized Patients with Cirrhosis. J. Clin. Med., 13.","DOI":"10.3390\/jcm13216377"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Jeon, H., Kim, J.H., Lee, S.S., Kim, H.J., Cha, R.R., Cho, H.C., Lee, J.M., Ha, C.Y., Kim, H.J., and Kim, T.H. (2021). Impact of acute kidney injury on survival in patients with chronic hepatitis C: A retrospective cohort study. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-05991-2"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1007\/s00535-024-02126-7","article-title":"Acute kidney injury development is associated with mortality in Japanese patients with cirrhosis: Impact of amino acid imbalance","volume":"59","author":"Miwa","year":"2024","journal-title":"J. Gastroenterol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.jhep.2024.03.031","article-title":"Acute kidney injury in patients with cirrhosis: Acute Disease Quality Initiative (ADQI) and International Club of Ascites (ICA) joint multidisciplinary consensus meeting","volume":"81","author":"Nadim","year":"2024","journal-title":"J. Hepatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1111\/jgh.14871","article-title":"Effect of acute kidney injury on long-term outcomes of spontaneous bacterial peritonitis in cirrhotic patients using the International Club of Ascites-acute kidney injury criteria","volume":"35","author":"Sohn","year":"2020","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Gessolo Lins, P.R., Carvalho Padilha, W.S., Magalhaes Giradin Pimentel, C.F., Costa Batista, M., and Teixeira de Gois, A.F. (2018). Risk factors, mortality and acute kidney injury outcomes in cirrhotic patients in the emergency department. BMC Nephrol., 19.","DOI":"10.1186\/s12882-018-1061-8"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1002\/jgh3.12467","article-title":"Acute kidney injury in hospitalized cirrhotic patients: Risk factors, type of kidney injury, and survival","volume":"5","author":"Khatua","year":"2021","journal-title":"JGH Open"},{"key":"ref_13","first-page":"8753764","article-title":"Incidence, Risk Factors, and Outcome of Acute Kidney Injury in the Intensive Care Unit: A Single-Center Study from Jordan","volume":"2020","author":"Oweis","year":"2020","journal-title":"Crit. Care Res. Pract."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1002\/hep4.1840","article-title":"Frailty and the Risk of Acute Kidney Injury Among Patients with Cirrhosis","volume":"6","author":"Cullaro","year":"2022","journal-title":"Hepatol. Commun."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1111\/apt.12299","article-title":"Predicting the development of acute kidney injury in liver cirrhosis--an analysis of glomerular filtration rate, proteinuria and kidney injury biomarkers","volume":"37","author":"Slack","year":"2013","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1146\/annurev-med-050223-112947","article-title":"Update on Hepatorenal Syndrome: From Pathophysiology to Treatment","volume":"76","author":"Khemichian","year":"2025","journal-title":"Annu. Rev. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1053\/j.akdh.2024.01.002","article-title":"Pathophysiology of Hepatorenal Syndrome","volume":"31","author":"Velez","year":"2024","journal-title":"Adv. Kidney Dis. Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1053\/j.gastro.2023.11.306","article-title":"Hepatorenal Syndrome in Cirrhosis","volume":"166","author":"Pose","year":"2024","journal-title":"Gastroenterology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1016\/j.jhep.2013.04.036","article-title":"A modified acute kidney injury classification for diagnosis and risk stratification of impairment of kidney function in cirrhosis","volume":"59","author":"Fagundes","year":"2013","journal-title":"J. Hepatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1016\/j.cgh.2022.12.034","article-title":"Recent Advances in the Management of Hepatorenal Syndrome: A US Perspective","volume":"21","author":"Patidar","year":"2023","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.hbpd.2023.08.004","article-title":"Prevalence and risk factors for impaired renal function among Asian patients with nonalcoholic fatty liver disease","volume":"23","author":"Sun","year":"2024","journal-title":"Hepatobiliary Pancreat. Dis. Int."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3602\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T19:44:50Z","timestamp":1778269490000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3602"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,8]]},"references-count":21,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15103602"],"URL":"https:\/\/doi.org\/10.3390\/jcm15103602","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,8]]}}}