{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T12:35:02Z","timestamp":1776861302314,"version":"3.51.2"},"reference-count":17,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Acute kidney injury (AKI) is a frequent and life-threatening complication in patients with liver cirrhosis (LC). Nephrotic-range proteinuria may reflect underlying structural renal vulnerability; however, its association with AKI severity in cirrhosis remains unclear. Materials and Methods: We conducted a retrospective cohort study of 408 adults with LC admitted to a tertiary referral hospital between January 2016 and December 2025. Nephrotic-range proteinuria was defined as a urine protein-to-creatinine ratio (UPCR) \u22653.5 g\/g measured within 7 days before or at admission. AKI was staged using serum creatinine-based Kidney Disease: Improving Global Outcomes criteria. Baseline creatinine was defined as the lowest value within 7 days before admission; if unavailable, the lowest stable value within the preceding 3 months was used. Severe AKI was defined as KDIGO stage 2\u20133. Multivariable logistic regression was performed to evaluate the association between nephrotic-range proteinuria and severe AKI after adjustment for age, sex, diabetes mellitus, hypertension, chronic kidney disease (CKD), sepsis, ICU admission, and Child\u2013Pugh class. Results: Of the 408 patients, 56 (13.7%) had nephrotic-range proteinuria. Severe AKI occurred more frequently in patients with nephrotic-range proteinuria than in those without (39.3% vs. 21.9%), corresponding to an absolute risk difference of 17.4 percentage points (p = 0.008). In the adjusted model, nephrotic-range proteinuria was associated with a higher likelihood of severe AKI (adjusted odds ratio [OR], 2.27; 95% confidence interval [CI], 1.17\u20134.41; p = 0.015). CKD (adjusted OR, 2.26; 95% CI, 1.33\u20133.81; p = 0.002), ICU admission (adjusted OR, 2.03; 95% CI, 1.22\u20133.39; p = 0.007), and Child\u2013Pugh class C versus A (adjusted OR, 3.50; 95% CI, 1.37\u20138.93; p = 0.009) were also significantly associated with severe AKI. Conclusions: Among hospitalized patients with LC, nephrotic-range proteinuria was associated with a higher likelihood of severe AKI. Quantitative proteinuria assessment may help identify patients at increased risk of advanced renal dysfunction, although causal inference is limited by the retrospective observational design.<\/jats:p>","DOI":"10.3390\/medicina62040797","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T10:38:14Z","timestamp":1776854294000},"page":"797","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk of Severe Acute Kidney Injury According to the Presence of Nephrotic-Range Proteinuria in Patients with Liver Cirrhosis: A Retrospective Cohort Study (2016\u20132025)"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7900-7560","authenticated-orcid":false,"given":"Seong Gyu","family":"Kim","sequence":"first","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, Duryugongwon-Ro 17-Gil 33, Nam-Gu, Daegu 42472, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1016\/j.jhep.2011.10.016","article-title":"Renal failure and cirrhosis: A systematic review of mortality and prognosis","volume":"56","author":"Fede","year":"2012","journal-title":"J. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Tandon, P., James, M.T., Abraldes, J.G., Karvellas, C.J., Ye, F., and Pannu, N. (2016). Relevance of New Definitions to Incidence and Prognosis of Acute Kidney Injury in Hospitalized Patients with Cirrhosis: A Retrospective Population-Based Cohort Study. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0160394"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"135","DOI":"10.14218\/JCTH.2019.00060","article-title":"Incidence, Mortality and Predictors of Acute Kidney Injury in Patients with Cirrhosis: A Systematic Review and Meta-analysis","volume":"8","author":"Tariq","year":"2020","journal-title":"J. Clin. Transl. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1016\/j.kint.2018.11.030","article-title":"Disparate outcomes observed within Kidney Disease: Improving Global Outcomes (KDIGO) acute kidney injury stage 1","volume":"95","author":"Sparrow","year":"2019","journal-title":"Kidney Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3984","DOI":"10.3748\/wjg.v27.i26.3984","article-title":"Acute kidney injury and hepatorenal syndrome in cirrhosis","volume":"27","author":"Gupta","year":"2021","journal-title":"World J. Gastroenterol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"m2687","DOI":"10.1136\/bmj.m2687","article-title":"Hepatorenal syndrome: Pathophysiology, diagnosis, and management","volume":"370","author":"Simonetto","year":"2020","journal-title":"Bmj"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1038\/nrgastro.2015.174","article-title":"The evolving concept of acute kidney injury in patients with cirrhosis","volume":"12","author":"Wong","year":"2015","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1016\/j.jhep.2014.12.029","article-title":"Diagnosis and management of acute kidney injury in patients with cirrhosis: Revised consensus recommendations of the International Club of Ascites","volume":"62","author":"Angeli","year":"2015","journal-title":"J. Hepatol."},{"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":"58","DOI":"10.1056\/NEJMra1214243","article-title":"Acute kidney injury and chronic kidney disease as interconnected syndromes","volume":"371","author":"Chawla","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1111\/bcp.12104","article-title":"Pathophysiology of proteinuria and its value as an outcome measure in chronic kidney disease","volume":"76","author":"Cravedi","year":"2013","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"144","DOI":"10.3109\/0886022X.2011.553301","article-title":"Acute kidney injury in adult idiopathic nephrotic syndrome","volume":"33","author":"Chen","year":"2011","journal-title":"Ren. Fail."},{"key":"ref_13","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_14","first-page":"1","article-title":"Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury","volume":"2","author":"Kellum","year":"2012","journal-title":"Kidney Int. Suppl."},{"key":"ref_15","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_16","doi-asserted-by":"crossref","unstructured":"Ichim, C., Boicean, A., Todor, S.B., Anderco, P., and B\u00eerlu\u021biu, V. (2025). Fecal Microbiota Transplantation in Patients with Alcohol-Associated Cirrhosis: A Clinical Trial. J. Clin. Med., 14.","DOI":"10.3390\/jcm14175981"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Dumitru, I.G., Todor, S.B., Ichim, C., Helgiu, C., and Helgiu, A. (2025). A Literature Review on the Impact of the Gut Microbiome on Cancer Treatment Efficacy, Disease Evolution and Toxicity: The Implications for Hematological Malignancies. J. Clin. Med., 14.","DOI":"10.3390\/jcm14092982"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/4\/797\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T11:35:08Z","timestamp":1776857708000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/4\/797"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,21]]},"references-count":17,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["medicina62040797"],"URL":"https:\/\/doi.org\/10.3390\/medicina62040797","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,21]]}}}