9. Profile of acute kidney injury in patients with decompensated chronic liver disease at a tertiary care center in North India

Abstract

Background and Aims: The hepato-renal syndrome (HRS) is a form of functional renal failure without renal pathology that occurs in about 10% of patients with advanced decompensated cirrhosis or acute liver failure. It is primarily caused due to marked disturbances in the arterial renal circulation in patients with cirrhosis; these include an increase in vascular resistance accompanied by a reduction in systemic vascular resistance. Methods: Study was conducted at Himalayan Institute of Medical sciences, Dehradun, India over a period of 12 months. Admitted patients of decompensated chronic liver disease were taken as subjects and aims of the study were to: to study prevalence of Acute Kidney Injury in patients with decompensated chronic liver disease, to classify patients with Acute Kidney Injury as pre-renal/renal/ post-renal cause, to identify prevalence of Hepato-renal syndrome in patients with Acute Kidney Injury in cirrhotic patients. Patient were diagnosed as having pre-renal acute kidney injury if their serum creatinine reduced by 0.3 mg/dl within 48 hours of admission after resuscitation with IV fluids (normal saline with or without albumin). In patients whom serum creatinine did not improve or worsen after adequate fluid resuscitation and fulfilling other diagnostic criteria were classified as hepato-renal syndrome. Patients with findings on microscopic urine examination (hematuria RBC > 50/HPF, proteinuria or cast in urine were classified as intrinsic renal disease. Patients were classified as having post renal azotemia if on imaging there is evidence of pelvi-calyceal dilatation. Results: A total of 175 patients were enrolled in the study. The Prevalence of AKI was found to be 43.7%, with pre-renal AKI – 71.23%, Intrinsic – 2.7% and Obstructive Uropathy – 1.35%. The prevalence of HRS was found to be 21.9%. Conclusions: Amongst the patient population AKI was seen in 67 patients and out of which 16 patients were found to have HRS. The authors have none to declare.