CHRONIC PYELONEPHRITIS AS A PRECIPITATING FACTOR OF HEPATORENAL SYNDROME IN PATIENTS WITH ALCOHOLIC LIVER CIRRHOSIS

Abstract

Introduction. Most attempts to assess renal failure in alcoholic liver cirrhosis have so far focused on acute kidney injury and on the hepatorenal syndrome in particular. However, there are still limited data on the prevalence and clinical impact of chronic kidney disease in cirrhosis. Objectives. This study aimed to assess the influence of chronic pyelonephritis on the incidence of hepatorenal syndrome in patients with alcoholic liver cirrhosis. Material and methods. 165 patients with decompensated alcoholic liver cirrhosis and concomitant chronic pyelonephritis were enrolled in the study. They were divided into two groups according to the presence or absence of chronic pyelonephritis: group 1 had alcoholic liver cirrhosis only (n=82), group 2 had alcoholic liver cirrhosis + chronic pyelonephritis (n=83). Results. The general bacterial infections were more common in group 1 patients. The spectrum of the most frequent bacterial complications in the examined patients typical for alcoholic liver cirrhosis was as follows: the share of urinary tract infection made up 16.0% (95% confidence interval 14.4-27.9), pneumonia constituted 16.7% (95% confidence interval 10.5-22.7, bacteremia made up 4.0% (95% confidence interval 7.7-38.6), the share of skin infections (erysipelas) was 2.7% (95% confidence interval 0.7-6.6). Other infections including pulmonary tuberculosis, lung abscess, right leg abscess, osteomyelitis, bedsores, were less common (6.7%). Spontaneous bacterial peritonitis, taking into account all options, was found in 6 cases (10.5%, 95% confidence interval 4.0-21.5). As expected, the incidence of hepatorenal syndrome within 14 days of inpatient onset was almost twice higher in group 2 – 22 cases (27%), than in group2 – 13 cases (16%). The group 2 demonstrated a more severe course of alcoholic liver cirrhosis on the Child-Pugh scale compared with group I (class B - 29.9%; class C - 70.1% against class B - 46.4%; class C - 53, 6% ); the differences were statistically significant (χ2 = 4.30, p = 0.038). In patients of group 2, the lethal outcome in the hospital occurred in 6 (8.9%) cases. Conclusions: The results of the present study confirm the role of chronic pyelonephritis as one of the major precipitating factors of hepatorenal syndrome incidence in patients with alcoholic liver cirrhosis. This fact should be considered when making the treatment plan for these patients.