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Functional renal alterations in chronic liver diseases
Insights
Chronic active hepatitis (CAH) frequently impairs kidney function, even in early stages. Studies show decreased renal blood flow and filtration, with increased prostaglandin E (PGE) levels and intrarenal shunts.
Area of Science:
- Nephrology
- Hepatology
- Internal Medicine
Background:
- Chronic active hepatitis (CAH) is a serious liver condition.
- Potential kidney involvement in CAH requires further investigation.
Purpose of the Study:
- To investigate kidney function in patients with CAH.
- To compare renal parameters in CAH patients with those suffering from chronic persistent hepatitis (CPH).
Main Methods:
- Studied 83 CAH patients (38 with cirrhosis) and 10 CPH controls.
- Assessed renal plasma flow, glomerular filtration rate, and performed selective renal arteriography and scintigraphy.
- Measured prostaglandin E1 (PGE1) and E2 (PGE2) levels.
Main Results:
- Tubular acidosis was frequently observed in CAH patients.
- CAH patients showed significantly decreased renal plasma flow and glomerular filtration rate compared to CPH.
- Renal arteriography revealed reduced arterial flow in the outer cortex; renal scans indicated tracer escape to the lungs.
- Elevated PGE1 and PGE2 levels were noted in the renal artery versus vein, particularly in cirrhotic CAH patients.
Conclusions:
- Kidney functional impairment is common in early stages of CAH.
- Increased PGE levels and the opening of intrarenal shunts may contribute to kidney dysfunction in CAH.
Abstract:
83 patients with chronic active hepatitis (CAH), 38 of them with cirrhosis, were studied and compared with 10 control subjects suffering from chronic persistent hepatitis (CPH). Tubular acidosis frequently was found in our cases. Renal plasma flow and glomerular filtration rate were significantly decreased in CAH when compared with CPH. Selective renal arteriography showed evident decrease of arterial flow in the outer cortex. Selective renal scan with 99mTc microspheres of human albumin showed a frequent escape of the tracer from the kidney to the lung. PGE1 and PGE2 levels appeared higher in the renal artery than in the vein and were significantly more elevated in 9 cases with cirrhosis vs. 13 controls. These results suggest the frequent functional impairment of the kidney also in the early stages of CAH, with an increase of PGE levels and an opening of intrarenal shunts.