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Can we predict early renal impairment in pediatric cirrhosis?

Durga Prasad1, Moinak Sen Sarma1, Surender Kumar Yachha2

  • 1Departments of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India.

Indian Journal of Gastroenterology : Official Journal of the Indian Society of Gastroenterology
|January 24, 2022
PubMed

Insights

Early detection of renal dysfunction in pediatric cirrhosis is possible using renal resistive index (RI). Abnormal baseline RI predicts poor outcomes, but paracentesis and albumin infusion can improve renal function.

Area of Science:

  • Pediatric Nephrology
  • Hepatology
  • Medical Imaging

Background:

  • Renal dysfunction (RD) is a serious complication in pediatric cirrhosis with limited early detection methods.
  • Assessing renal function through renal resistive index (RI) and plasma aldosterone (PA) is crucial for managing cirrhotic children.

Purpose of the Study:

  • To detect early renal dysfunction (RD) in pediatric cirrhosis using renal resistive index (RI) and plasma aldosterone (PA).
  • To evaluate the impact of large-volume paracentesis (LVP) and albumin infusion on renal function in these patients.

Main Methods:

  • Prospective enrollment of non-azotemic cirrhotic children with tense ascites undergoing LVP and albumin infusion.
  • Measurement of blood biochemistry, RI via Doppler ultrasonography, and PA at regular intervals.
  • Inclusion of chronic liver disease children without ascites as controls.

Main Results:

  • Children with tense ascites showed significantly higher baseline RI than controls (p<0.001).
  • Baseline RD was observed in 32% of cirrhotic children, significantly higher in those with tense ascites (59% vs. 4%, p<0.001).
  • RD at admission predicted higher risks of acute kidney injury (AKI), ascites recurrence, hospital readmission, and mortality.
  • LVP with albumin significantly reduced RI post-procedure.
  • Pediatric End-stage Liver Disease (PELD) score and PA strongly correlated with baseline RI and predicted AKI and mortality.

Conclusions:

  • Abnormal baseline RI serves as an early predictor of RD and long-term renal outcomes in pediatric cirrhosis.
  • Baseline RI correlates with liver disease severity and PA levels.
  • Paracentesis and albumin infusion effectively improve renal resistive index (RI) in cirrhotic children.
Abstract

Keywords:
Acute kidney injuryAlbuminChildrenCirrhosisDopplerPlasma aldosteroneRenal dysfunctionResistive indexSerum creatinineTense ascites

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