Assessment of renal functions in patients of chronic liver disease.
OBJECTIVE
Renal involvement in patients of chronic liver disease (CLD) is one of the dreaded complications associated with a steep rise in mortality and morbidity. Derangements in various homeostatic mechanisms in CLD leading to direct renal injury or circulatory compromise have been associated with renal impairment.


METHODS
Consecutive cirrhotic patients (n = 100) were included in the study. Structural and functional renal failure was identified and patients were classified into various renal syndromes pre renal, intra-renal and hepatorenal syndrome (HRS).


RESULTS
At the time of presentation, 37 patients had renal dysfunction. Thirty patients had pre-renal type of renal failure, six patients had intrinsic renal disease and one patient had structural renal disease. Patients with pre-renal type were further classified into volume responsive pre-renal failure and volume non responsive HRS. Five patients had features suggestive of HRS. Patients with decompensation such as portal hypertension (PHTN), jaundice, upper gastro-intestinal bleed and hepatic encephalopathy had significantly higher incidence of renal derangements as compared to their counterparts. Infection in the form of SBP and/or sepsis predisposed patients to develop renal dysfunction.


CONCLUSIONS
Renal impairment in patients with advanced liver disease is not an uncommon phenomenon and is more commonly associated with a more advanced disease. Presence of PHTN and various signs of decompensation increase the chances of renal derangements in these patients. In view of rising incidence of CLD and higher survival (due to better treatment options available), one should be vigilant for the renal derangements in these patients.
a Department of Medicine and Division of Nephrology , Pt. B.D. Sharma University of Health Sciences , Rohtak , Haryana , India.
H K
HK
Aggarwal
a Department of Medicine and Division of Nephrology , Pt. B.D. Sharma University of Health Sciences , Rohtak , Haryana , India.
Deepak
D
Jain
a Department of Medicine and Division of Nephrology , Pt. B.D. Sharma University of Health Sciences , Rohtak , Haryana , India.
Suhas
S
Singla
a Department of Medicine and Division of Nephrology , Pt. B.D. Sharma University of Health Sciences , Rohtak , Haryana , India.
Promil
P
Jain
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006530:Hepatorenal Syndrome / Q000175:diagnosis*; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis*; D007677:Kidney Function Tests; D008107:Liver Diseases / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D051437:Renal Insufficiency / Q000175:diagnosis*; D012720:Severity of Illness Index; D055815:Young Adult
Chronic liver disease; hepatorenal syndrome; portal hypertension; renal failure