CLINICAL PROFILE OF ACUTE KIDNEY INJURY IN CHRONIC LIVER DISEASE, AND ITS EFFECT ON IN HOSPITAL MORTALITY

Abstract

Introduction - Chronic liver disease (CLD) is a common clinical condition affecting mankind.Its association with the diseases of other important organs like kidney makes it a more devastating disease. Acute kidney injury (AKI) considerably affects the prognosis and outcome of patients with CLD, hence it is important to prevent the development of AKI and identify the precipitating factors as early as possible, so that early interventions can be done.1 A prospective observational study was done on 100 chronic liver disease patients admitted in J. A. group ofMaterial and methods - hospitals Gwalior, over a period of 22 months from Nov. 2019 to June 2021. Detailed history and physical examination, biochemical and radiological investigations were performed and data was collected using a standardised proforma. Out of the 100 patients 70 are patientsResults - are male and 30 are females. Most of the patients belonged to Child - Pugh class C (60%), followed by class B (39%) and class A (1%).Overall, alcohol was found to be the most common cause of chronic liver disease (59%), followed by hepatitis B virus infection (20%), Hepatitis C virus infection(6%), NASH related CLD(2%), portal vein thrombosis(5%), Wilson's disease (1%), unknown etiology (7%). In males, the most common cause of CLD was found to be chronic alcoholism(84.3%), followed by hepatitis B virus infection(8.6%), portal vein thrombosis and NASH related hepatitis in 2.8% each and Wilson's disease (1.4%). In females most common cause of CLD was found to be hepatitis B virus infection (46.6%),followed by hepatitis c virus infection (20%), portal vein thrombosis(10%), unknown etiology (23.3%). Ascites (78%) was the most common sign of hepatic decompensation, followed by pedal edema (67%), jaundice (52%), altered sensorium(20%), GI bleed ( 22%), dilated abdominal veins(18%), alopecia(10%). palmar erythema ( 8 %) and testicular atrophy(4%). Prevalence of AKI in CLD was found to be 30%, out of which maximum no. of patients were in AKIN stage 3(48%), frequency of stage 1 & 2 AKI was 26.6% each. The most common cause of AKI in CLD was found to be sepsis (40%), followed by GI bleed (26.7%), inappropriate use of diuretics (13. 3%), Paracentesis (6.6%)and diarrhea(10%) severe vomiting ( 3. 3%). The in hospital mortality in the patients who developed AKI was considerably higher (56.6%) than the patients who did not developed AKI (8.5%), signicant at p <0.05. CLD patients are at increased risk of developing AKI , and mortality rates areConclusion - signicantly higher in patients of CLD complicated by AKI.