STUDY OF CLINICAL PROFILE OF PATIENTS WITH ACUTE KIDNEY INJURY IN LIVER DISEASES. IN TERTIARY CARE CENTRE OF NORTH INDIA

Main Article Content

Dr Shaurya Goyal
Dr Vivek Ahuja
Dr Sudhir Mehta
Dr Aakash Aggarwal

Keywords

AKI, ATN, HRS, Liver Disease, Mortality, PRA

Abstract

Background: The clinical profile of patients with acute kidney injury in liver diseases has many causes. Among them Pre renal AKI is superior to Acute tubular necrosis and Hepato- Renal syndrome. Acute kidney damage in patients with liver cirrhosis is linked to a significant in-hospital death rate.


Aim: To study the clinical profile of patients with acute kidney injury in liver diseases.


Material & Methods: From December 1, 2022, to November 30, 2023, the gastroenterology patient department at the MM Institute of Medical Sciences Mullana, Ambala, was the site of this prospective observational study. The study comprised 100 cases of individuals who were older than 18 years old & had been diagnosed with either acute or chronic liver disease with signs of acute kidney injury according to KIDGO criteria. Complete hemogram, conjugated & unconjugated bilirubin, serum total bilirubin, serum albumin, serum globulin, serum PT (prothrombin time)/INR, blood urea (BU), alkaline phosphatase, serum creatinine (sCr) at admission & every day until the patient gets better or is discharged, & baseline reports were recorded during the hospital stay.


Results: Of the individuals, 37% had a history of prerenal azotemia (PRA), 34% of acute tubular necrosis (ATN), & 29% had a history of hepatorenal syndrome (HRS). Subjects with PRA had the highest mean serum creatinine levels, whereas subjects with HRS had higher mean blood pressure. The participants with PRA, HRS, & ATN had mean hospital stays of 9.78±1.13, 12.55±1.09, & 10.02±1.14, respectively. 38% of the patients indicated their overall mortality. The participants with ATN had the highest recorded death rate (55.88%), followed by HRS (44.83%).


Conclusion: Acute kidney damage in patients with liver cirrhosis is linked to a significant in-hospital death rate. The two main indicators of in-hospital mortality are oliguria & a greater stage of AKI at presentation. The outcome of pre-renal AKI is superior to that of ATN or HRS. 

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References

1. Waikar SS, Bonventre JV. Acute Kidney Injury. In: Kasper DL, Fauci AS, Hauser SL, Congo DL, Jameson JL, Loscalzo J, editors. Harrison’s Principles of Internal Medicine. 19th ed. New York (NY): McGraw Hill; 2015. pp. 1799–811.
2. Singbartl K, Kellum J. AKI in the ICU: definition, epidemiology, risk stratification, & outcomes. Kidney International. 2012;81(9):819–825.
3. Suk KT. Hepatic venous pressure gradientclinical use in chronic liver disease. Clin Mol Hepatol. 2014 Mar;20(1)6-14.
4. Gerbes AL. Liver cirrhosis & kidney. Dig Dis. 2016;34(4):387–90.
5. Lei L, Li L, Zhang H. Advances in the diagnosis & treatment of acute kidney injury in cirrhosis patients. BioMed Res Int. 2017;2017: 8523649.
6. Mukherjee PS, Vishnubhatla S, Amarapurkar DN, Das K, Sood A, Chawla YK, et al. Etiology & mode of presentation of chronic liver diseases in India: A multi centric study. PLoS One. 2017 Oct;12(10):e0187033.
7. Angeli P, Gine’s P, Wong F, et al. Diagnosis & management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. J Hepatol. 2015;62:968–74.
8. Tariq R, Hadi Y, Chahal K, Reddy S, Salameh H, Singal AK. Incidence, mortality & predictors of acute kidney injury in patients with cirrhosis: a systematic review & meta-analysis. J Clin Transl Hepatol. 2020;8:135–142.
9. Purohit A, Pahawa N, Vohra R, Goswami S, Raju B, Malviya V, et al. Clinical spectrum of AKI in chronic liver diseases. Int J Med Res Rev. 2019;7(2):80-85.
10. Allegretti AS, Ortiz G, Wenger J, Deferio JJ, Wibecan J, Kalim S, et al. Prognosis of acute kidney injury & hepatorenal syndrome in patients with cirrhosis: a prospective cohort study. International journal of nephrology. 2015 Jul 22;2015.
11. Mohan J, Narayanasamy K, Ramalingam S. Clinical profile of renal dysfunction in cirrhotic liver. Int J Biomed Res. 2016 Feb 7;7(2):073-6.
12. Fleming KM, Aithal GP, Solaymani-Dodaran M. Incidence & prevalence of cirrhosis in the United Kingdom, 1992-2001- a general population-based study. J Hepatol. 2008 Nov;49(5)732-8.
13. Prakash J, Mahapatra A, Ghosh B, et al. Clinical Spectrum of Renal Disorders in Patients with Cirrhosis of Liver, Renal Failure. J Kidney diseases in cirrhotic patients. 2011 Jan;33;1;40-46.
14. Nall S, Arshad H, Contractor B, et al. Predictors of Acute Kidney Injury in Patients Hospitalized With Liver Cirrhosis: A Systematic Review & Meta-Analysis. Cureus 2024;16(1): e52386.
15. Tariq R, Hadi Y, Chahal K, Reddy S, Salameh H, Singal AK: Incidence, mortality & predictors of acute kidney injury in patients with cirrhosis: a systematic review & meta-analysis. J Clin Transl Hepatol. 2020, 8:135-42.
16. Bunchorntavakul C, Chamroonkul N, Chavalitdhamrong D: Bacterial infections in cirrhosis: a critical review & practical guidance. World J Hepatol. 2016, 8:307-21.
17. Vaidya M, Sarate N, Kawale J, Pai V. A study of acute kidney injury in cirrhosis of liver. European Journal of Molecular & Clinical Medicine. 2022 Jan 15;9(2):26-35.