Experiences with acute kidney injury complicating non-fulminant hepatitis A.
OBJECTIVE
To describe the clinical features and to identify factors related to development of acute kidney injury in acute hepatitis A patients.


METHODS
The study and control groups consisted of 21 and 425 patients who did or did not develop acute kidney injury, respectively, after acute hepatitis A from January 1997 to May 2007.


RESULTS
There were 13 men and eight women; their mean age at diagnosis was 28.8 +/- 8.2 years in the study group. Peak values for renal and liver function impairment consisted of a median serum creatinine of 4.6 mg/dL (range, 1.5-15.3 mg/dL) on day 6 (range, days 1-20) and a median total bilirubin of 10.7 mg/dL (range, 2.6-57.5 mg/dL) on day 8 (range, day 1-19). Serum creatinine concentrations returned to baseline level by a median of 16 days and total bilirubin levels returned to normal by a median of 62 days. Six of 21 (29%) patient underwent haemodialysis. Renal biopsies performed in two patients showed acute tubular necrosis and interstitial nephritis, respectively. Logistic regression analysis showed that a lower haematocrit, the presence of coagulopathy and high C-reactive protein concentration on admission, and higher peak bilirubin value during the illness were associated with development of acute kidney injury.


CONCLUSIONS
Acute hepatitis A should be considered in the differential diagnosis of patients with acute kidney injury, even without fulminant hepatic failure. A lower haematocrit, the presence of coagulopathy and high C-reactive protein level at presentation, and higher peak bilirubin level during the illness were associated with development of acute kidney injury in acute hepatitis A patients.
Division of Nephrology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Korea.
Hyun W
HW
Kim
Mi H
MH
Yu
Jang H
JH
Lee
Jai W
JW
Chang
Won S
WS
Yang
Soon B
SB
Kim
Sang K
SK
Lee
Jung S
JS
Park
Su-Kil
SK
Park
D000208:Acute Disease; D000328:Adult; D001706:Biopsy; D002097:C-Reactive Protein / Q000032:analysis; D003404:Creatinine / Q000097:blood; D005260:Female; D006506:Hepatitis A / Q000150:complications*; D006801:Humans; D007668:Kidney / Q000473:pathology; D007674:Kidney Diseases / Q000209:etiology*; D008297:Male
D002097:C-Reactive Protein; D003404:Creatinine