Clinical spectrum of AKI in chronic liver diseases
Abstract
Introduction: Acute kidney injury (AKI) is a heterogeneous syndrome of different aetiologies, and often multifactorial. Occurrence of Acute kidney injury in patients with chronic liver disease is frequent finding which makes prognosis of CLD even poorer.
Material and methods: A prospective cohort observational study on 100 adult patients of chronic liver disease with AKI conducted over a period of 24 months from August 2016 to August 2018 at Sri Aurobindo medical college and postgraduate institute. Detailed clinical examination and biochemical tests were done. Univariate and multivariate logistic regression (odds ratio) analyses were used.
Result: 87% are males and 13 % are females. The most common cause of cirrhosis is alcoholic 77% followed by hepatitis Bvirus related 10%, unknown etiology 7%, hepatitis C 3%, NASH 2%, Wilson 1. The most common sign of decompensation of liver is jaundice 78% followedby ascites 70%, hepatic encephalopathy 37% and upper GI bleed 30%. Distribution of child class as a prognostic indicator showed the maximum no. ofpatients found in class C 56% followed by class B 34% and class A 10%.
Conclusion: Acute kidney injury is very common in chronic liver disease patient in our hospital and majority of them have intrinsic cause of AKI
Downloads
References
Suk KT. Hepatic venous pressure gradient: clinical use in chronic liver disease. Clin Mol Hepatol. 2014 Mar;20(1):6-14. doi: https://dx.doi.org/10.3350%2Fcmh.2014.20.1.6. Epub 2014 Mar 26.
Garcia-Tsao G, Parikh CR, Viola A. Acute kidney injury in cirrhosis. Hepatology. 2008 Dec;48(6):2064-77. doi: https://doi.org/10.1002/hep.22605.
Angeli P, Gines P, Wong F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. Gut. 2015 Apr;64(4):531-7. doi: http://dx.doi.org/10.1136/gutjnl-2014-308874. Epub 2015 Jan 28.
Garcia-Tsao G, Parikh CR, Viola A.Acute kidney injury in cirrhosis. Hepatology. 2008 Dec;48(6):2064-77. doi: 10.1002/hep.22605.
D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006;44:217–231. doi: https://doi.org/10.1016/j.jhep.2005.10.013.
du Cheyron D, Bouchet B, Parienti JJ, et al. The attributable mortality of acute renal failure in critically ill patients with liver cirrhosis. Intensive Care Med. 2005 Dec;31(12):1693-9. Epub 2005 Oct 22.
Bonnel AR, Bunchorntavakul C, Reddy KR. Immune dysfunction and infections in patients with cirrhosis. Clin Gastroenterol Hepatol. 2011 Sep;9(9):727-38. doi: https://doi.org/10.1016/j.cgh.2011.02.031. Epub 2011 Mar 11.
Fasolato S, Angeli P, Dallagnese L, et al. Renal failure and bacterial infections in patients with cirrhosis: epidemiology and clinical features. Hepatology. 2007 Jan;45(1):223-9.
Marc G. Ghany, Jay H. Hoofnagle (2015). Harrison's principles of internal medicine,19th edition: volume 2, chapter 357; 1989-1995. New York: McGraw Hill Education.
S Allegretti, Andrew, Ortíz, Guillermo, Wenger, Julia, Deferio et al. Prognosis of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis: A Prospective Cohort Study. International journal of nephrology. 2015. 108139.doi: https://doi.org/10.1155/2015/108139.
Jaiganesh Mohan et al / International Journal of Biomedical Research 2016; 7(2): 073-076. IJBR (2016) 7 (02) www.ssjournals.com, International Journal of Biomedical Research , ISSN: 0976-9633 (Online); 2455-0566 (Print) ,Journal DOI: http://dx.doi.org/10.7439/ijbr .
Fleming KM, Aithal GP, Solaymani-Dodaran M, et al. Incidence and prevalence of cirrhosis in the United Kingdom, 1992-2001: a general population-based study. J Hepatol. 2008 Nov;49(5):732-8. doi: https://doi.org/10.1016/j.jhep.2008.05.023. Epub 2008 Jun 25.
Prakash J, Mahapatra A, Ghosh B, et al.Clinical Spectrum of Renal Disorders in Patients with Cirrhosis of Liver, Renal Failure, J Kidney diseases in cirrhotic patients 2011 Jan; 33:1, 40-46, DOI: https://doi.org/10.3109/0886022X.2010.541582. Epub 2011 Jan 10.
Muhammad Omar Qureshi, Farzana Shafqat, Faisal Saud Dar, Mohammad Salih and Nasir Khokhar; ‘Renal Failure in Patients with End Stage Liver Disease and its Impact on Clinical Outcome’; Journal of the College of Physicians and Surgeons Pakistan 2014, Vol. 24 (9): 628-631.
Nupur Das, Agnihotri Bhattacharyya, BaishakhiParia, and Sujoy Sarkar “Study on Assessment of Renal Function in Chronic Liver Disease”J Clin Diagn Res. 2015 Mar; 9(3): OC09–OC12. Published online 2015 Mar 1. doi: https://dx.doi.org/10.7860%2FJCDR%2F2015%2F11423.5658
Brij Sharma, RishabMarwah, Sujeet Raina, Neetu Sharma, Madan Kaushik, Satinder Singh Kaushal. A study on the etiology of cirrhosis of liver in adults living in the Hills of Himachal Pradesh, India. DOI: http://dx.doi.org/10.7869/tg.317
Apurva S, Shah, Deepak N, Amarapurkar, Natural History of cirrhosis of liver after First Decompensation: A Prospective Study In India. Journal of clinical and Experimental Hepatology/xx2017/Vol.xx/No.xx/1-8.
Kirk B Russ, Todd M stevens and Ashwani K. Singal, Acute kidney injury in patients with Cirrhosis. Journal of Clinical and Translational Hepatology 2015;3(3):195-204
Qun-Qun Jiang, Mei-Fang Han, Ke Ma, Guang Chen, Xiao-Yang Wan, SemvuaBukhetiKilonzo. Acute kidney injury in acute-on-chronic liver failure is different from in decompensated cirrhosis. World J Gastroenterol. 2018 Jun 7; 24(21): 2300–2310. Published online 2018 Jun 7. doi: https://dx.doi.org/10.3748%2Fwjg.v24.i21.2300.
Ashok Kulkarni, Amol & Rao, P.N. &Hussaini, Shaistam& Reddy, Nageshwar. Clinical profile, precipitating factors & in-hospital mortality of acute kidney injury in cirrhosis of liver. Journal of Clinical and Experimental Hepatology. 3.S94. doi: https://doi.org/10.1016/j.jceh.2013.02.236.
Attia KA, N'driYoman AT, Mahassadi AK, Impact of renal failure on survival of African patients with cirrhosis. Saudi J Kidney Dis Transpl. 2008;19(4):587–592.
Andrew S. Allegretti, Guillermo Ortiz,1Julia Wenger, Joseph J. Deferio,1 Joshua Wibecan,1Sahir Kalim. Prognosis of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis: A Prospective Cohort Study. International Journal of NephrologyVolume 2015, Article ID 108139, 9 pages http://dx.doi.org/10.1155/2015/108139
OAI - Open Archives Initiative
