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Acute Kidney Injury in Chronic Liver Disease in Northwest India: Still a Battle to Conquer
Disha Saxena1, Manoj Yadav2, Tarun Kumar1
1Department of Nephrology, SMS Medical College and Hospital, Jaipur, Rajasthan, India.
Insights
Acute kidney injury (AKI) is common in cirrhosis patients, with pre-renal causes being most frequent. AKI severity correlates with liver disease scores, and renal biopsy aids management in non-responders.
Area of Science:
- Nephrology
- Hepatology
- Internal Medicine
Background:
- Cirrhosis patients frequently develop acute kidney injury (AKI), leading to adverse outcomes.
- AKI is a significant complication in liver disease management.
Purpose of the Study:
- To evaluate the spectrum of acute kidney injury (AKI) in patients with cirrhosis.
- To understand the causes, stages, and outcomes of AKI in a cirrhotic population.
Main Methods:
- A prospective study of consecutive cirrhotic patients with AKI admitted to a tertiary care center in India.
- Data collection included patient history, clinical examination, and laboratory investigations.
Main Results:
- 243 patients were enrolled; 91.3% were male. Alcohol was the most common cirrhosis etiology (58.4%).
- Pre-renal AKI occurred in 54.4%, hepatorenal syndrome (HRS) in 21.8%. IgA nephropathy was the commonest glomerular pathology.
- AKI stages correlated significantly with Child-Turcotte-Pugh (CTP) and MELD-Na scores. In-hospital mortality was 18.5%.
Conclusions:
- Pre-renal factors are the primary cause of AKI in cirrhotic patients.
- AKI severity is linked to liver disease prognostic scores.
- Renal biopsy is recommended for non-responsive AKI cases to guide treatment.
Background:
Patients with cirrhosis are susceptible to development of acute kidney injury (AKI), which leads to poor outcome. We conducted a study to evaluate the spectrum of AKI in patients with cirrhosis.
Materials And Methods:
This study was conducted in consecutive cirrhotic patients with AKI admitted in a tertiary care center of India from April 2020 to December 2022. Details including history, examination findings, and results of laboratory investigations were recorded.
Results:
A total of 243 patients were enrolled in this study. The majority (91.3%) of the patients were males. The most common etiology of cirrhosis was alcohol in 58.4% (n = 142) followed by hepatitis B in 10.3% (n = 25) of patients. Pre-renal form of AKI was present in 54.4% (n = 132) of patients and hepatorenal syndrome (HRS) in 21.8% (n = 53) of patients. IgA nephropathy was the commonest (n = 6) glomerular pathology in nonresponders with intrinsic renal disease. Majority of the patients belonged to stage II (46.9%) and stage I AKI (37%), while only 16.1% had stage III AKI. Various stages of AKI showed a significant correlation (P < 0.05) with Child-Turcotte-Pugh (CTP) score and Model for End-stage Liver Disease (MELD)-Na score. The overall in-hospital mortality rate was found to be 18.5% (n = 45).
Conclusion:
Renal dysfunction is a frequent complication among cirrhotic patients. Pre-renal factors were the most common cause of AKI in cirrhotics. Stages of AKI showed significant correlation with liver prognostic scores. Renal biopsy should be considered in patients not responding to treatment, to guide further management.
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