Renal Dysfunction Across Etiologies of Chronic Liver Disease: A Cross-Sectional Study From a Tertiary Care Center

Chronic liver disease (CLD) is a rapidly growing public health challenge globally. Kidney complications are a frequent and serious consequence of CLD, significantly increasing the risk of illness and death. Despite this, renal involvement in newly diagnosed or previously untreated CLD remains incompletely understood.

This study evaluated baseline renal function in patients with newly diagnosed CLD and examined the association between specific etiologies, particularly metabolic dysfunction-associated steatotic liver disease (MASLD), and patterns of overt or subclinical renal dysfunction.

A cross-sectional observational study was conducted involving 79 adults newly diagnosed with untreated CLD at a tertiary care hospital in India between March 2023 and August 2024. Individuals with known chronic kidney disease, prior treatment for decompensated CLD, or recent exposure to nephrotoxic medications were excluded. Renal function assessment included standard blood tests, 24-hour urine collections, and estimated glomerular filtration rate (GFR) calculations. To evaluate suspected subclinical renal injury, renal biopsy was performed in 40 clinically selected patients with proteinuria, active urinary sediment, reduced GFR, or suspected glomerular disease.

The cohort was predominantly composed of middle-aged men, with a mean age of 49.26 years. Alcohol-related liver disease was the most common etiology, affecting 39 patients (49.4%), followed by MASLD (14 patients, 17.7%) and viral hepatitis (B and C combined) (10 patients, 12.7%). Despite 71 patients (88.6%) exhibiting normal serum creatinine levels, biopsies (n=40) revealed substantial underlying structural abnormalities. Non-glomerular lesions were identified in 35 (87.5%) of biopsied cases, while IgA nephropathy was the most frequent glomerular pathology, present in 18 (45.0%) biopsied patients. Overall, nine (11.4%) of the cohort had a reduced GFR, defined as <60 mL/min/1.73m². Patients with MASLD demonstrated a significantly higher prevalence of reduced GFR compared to those with alcohol-related disease, i.e., four (28.6%) versus two (5.1%), corresponding to more than a sevenfold increase in the odds of renal dysfunction.

Subclinical structural renal damage may be common in the early stages of CLD and often precedes detectable changes in routine blood tests. MASLD is associated with a markedly increased risk of reduced GFR compared to other etiologies. Early and concurrent assessment of renal function in patients with newly diagnosed CLD is critical for identifying subclinical impairment and informing timely clinical management.