Title: Clinical Spectrum of Renal Dysfunction in Cirrhosis of Liver
Authors: Dr Twinkle Chandrakar, Dr Tanuja Manohar, Dr Nalini Humaney
DOI: https://dx.doi.org/10.18535/jmscr/v5i3.83
Abstract
Introduction: Renal dysfunction is a common and serious problem in patients with advanced liver disease. Physicians involved in the care of patients of cirrhosis recognize that the development of renal dysfunction is associated with significant morbidity and mortality. Hence it is very important to diagnose condition early and recognize type of renal failure in order to decide further therapy.
Methods-This was a prospective single centered observational study was conducted on 100 patients with cirrhosis of liver admitted in a tertiary care hospital, according to inclusion and exclusion criteria during the study period Jan 2015 to Jul 2016. After collecting details of demographic data, subjects underwent complete general & systemic examination and later subjected to blood investigations, ultrasonography abdomen and kub, urine examination and upper gastrointestinal endoscopy. Child-pugh score and MELD score was calculated.
Result- In this study, Renal dysfunction was present in 40% of population which was later categorized according to the type of renal involvement. 21% of total study population was identified to develop acute kidney injury, which was most common presentation for renal involvement and 18% were found to have hepatorenal syndrome. Only one (1%) patient was diagnosed as chronic kidney disease. The most common etiology found for liver cirrhosis was alcoholic cirrhosis in both groups with or without renal dysfunction. In our study population total 16 patients were succumbed during hospitalization and all are belong to hepatorenal syndrome. Among the patients with fatal outcome maximum patients were male and had complications of spontaneous bacterial peritonitis, esophageal varices and were in CP class C with higher MELD score. Presence of spontaneous bacterial peritonitis and gastrointestinal bleed were major factors those were significantly associated with development of HRS. These factors alone or in combination were responsible for development of hepatorenal syndrome.
Conclusion-Renal dysfunction is a frequent and dreaded complication of cirrhosis of liver. An attempt should always be made to identify it early and categorize patients in different groups as treatment and prognosis differs in these subgroups. Patients usually have downhill course once hepato-renal syndrome develops while patients with AKI because of pre-renal azotemia can be successfully treated if detected early.
