Study of the Rela
Study of the Relationship between the Cause of Renal Failure and Outcome in Decompensated Liver Cirrhosis
Gamal F. El Naggar, Khaled Zaghloul, Loai El Ahwal, and Mahmoud F. Selim
Department of Internal Medicine, Faculty of Medicine, Tanta University
Abstract: Background: Renal failure is a challenging complication of cirrhosis and is one of the most important risk factors when liver transplantation is being considered. Patients with cirrhosis and renal failure are at high risk for death while awaiting transplantation and have an increased frequency of complications and reduced survival after transplantation, as compared with those without renal failure. Aims: To evaluate the causes of renal failure in patients with decompansated liver cirrhosis and its impact on prognosis. Patients & Methods: One hundred patients with decompansated liver cirrhosis associated with renal failure (serum creatinine equal to or more than 1.5 mg/dl) were included in our study; they were classified according to the cause of renal failure into 4 groups: hepatorenal syndrome, infection, hypovolemia and parenchymal kidney disease. All patients in the study were subjected to full history taking, complete clinical examination, pelviabdominal ultrasonography, chest X ray and laboratory investigations including blood urea, serum creatinine, urine analysis, ascitic fluid analysis, serum sodium, serum potassium, urinary sodium, and serum osmolarity. Results: 37 patients (37%) developed renal failure due to hepatorenal syndrome, 31 patients (31%) due to infection especially spontaneous bacterial peritonitis, 22 patients (22%) due to hypovolemia especially upper and lower gastrointestinal bleeding and 10 patients (10%) due to parenchymal kidney disease. There was statistically non - significant increased incidence of diabetes melllitus among group II (infection group) as compared to other groups (p. value 0.054). Prognosis depends on the cause of renal failure as 16 patients of hepatorenal syndrome died within 2 weeks of admission, 5 patients died due to infection, 4 patients died due to hypovolemia and no patients died due to parenchymal kidney disease. There was statistically significant difference in outcome among studied groups (p. value 0.001). Conclusions: A simple classification of patients with decompansated liver cirrhosis according to cause of renal failure is useful in assessment of prognosis and may help in decision making in liver transplantation.
[Gamal F. El Naggar, Khaled Zaghloul, Loai El Ahwal, and Mahmoud F. Selim Study of the Relationship between the Cause of Renal Failure and Outcome in Decompensated Liver Cirrhosis . J Am Sci2013;9(3):112-118]. (ISSN: 1545-1003). http://www.jofamericanscience.org. 15
Key words: renal failure, decompensated liver cirrhosis, and hepatorenal syndrome. Full Text 15
