title: The spectrum of renal lesions in patients with cirrhosis: a clinicopathological study.
abstract: OBJECTIVE
  Little is known on the morphological changes in the kidneys of cirrhotic patients with abnormal urinalysis and/or high serum creatinine levels. This retrospective, one-point-in-time study aimed to report the results of the analysis of renal biopsy specimens obtained in patients with cirrhosis.
  
  
  METHODS
  We retrieved information on 65 patients who underwent transvenous renal biopsy for proteinuria >0.5 g/day and/or microscopic haematuria and/or unexplained renal impairment (defined by serum creatinine levels >1.5 mg/dl).
  
  
  RESULTS
  Fifty-one per cent of the patients had proteinuria >0.5 g/day, 58% had haematuria and 83% had renal impairment. Renal biopsy disclosed injury to glomeruli in 77% of the patients, to vessels in 69% and to the tubulointerstitium system in 94% (chronic in 77%; acute in 75%). Fibrous endarteritis was the most common renal vascular lesion. Injuries to different structures were frequently combined. Isolated glomerular alterations were found in only two patients. Acute tubular necrosis was significantly more common in patients with fibrous endarteritis than in those without. Among 18 patients with renal impairment, proteinuria <0.5 mg/day and no haematuria, 10 had glomerular lesions, 13 had chronic tubulointerstitial lesions and 12 acute tubulointerstitial lesions.
  
  
  CONCLUSIONS
  In patients with cirrhosis, various types of renal injuries are frequently combined. Chronic lesions (vascular or tubulointerstitial) may influence the outcome, in particular in patients who subsequently undergo liver transplantation and receive anticalcineurins. Renal vascular lesions may increase the risk of acute tubular necrosis. In patients with renal impairment, the absence of significant proteinuria and haematuria do not rule out the presence of renal lesions.
authors.affiliation: Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Trawalé
authors.forename: Valérie
authors.initials: V
authors.lastname: Paradis
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Rautou
authors.forename: Claire
authors.initials: C
authors.lastname: Francoz
authors.forename: Sylvie
authors.initials: S
authors.lastname: Escolano
authors.forename: Marion
authors.initials: M
authors.lastname: Sallée
authors.forename: François
authors.initials: F
authors.lastname: Durand
authors.forename: Dominique
authors.initials: D
authors.lastname: Valla
authors.forename: Didier
authors.initials: D
authors.lastname: Lebrec
authors.forename: Richard
authors.initials: R
authors.lastname: Moreau
mesh_terms: D001706:Biopsy; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007678:Kidney Glomerulus / Q000473:pathology; D008103:Liver Cirrhosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D003404:Creatinine