KIDNEY HISTOLOGICAL CHANGES IN HEPATORENAL SYNDROME AGAINST A BACKGROUND OF THE ALCOHOLIC LIVER CIRRHOSIS

Abstract

Objective. Assessment of the significance of histological changes in the kidneys at hepatorenal syndrome and their correlation with clinical and laboratory data in this pathology.Material and methods. To achieve this goal, 152 patients were examined using clinical, laboratory and instrumental methods. We estimated glomerular filtration rate, the dopplerographic index of vascular resistance in the renal arteries, as well as the indices of histological damage at autopsy of the kidneys — glomerulosclerosis, arteiolosclerosis, and tubulo-interstitial kidney damage.Results. Evaluation of only clinical or non-invasive markers showed that high vascular resistance index, high systolic blood pressure, high urinary protein level and low glomerular filtration are the independent risk factors for the progression of renal dysfunction. The vascular resistance index grew in proportion to the increase of creatinine level. It inversely correlated with kidney function and directly correlated with histological lesion scores, among which the strongest correlation was with the tubulo-interstitial lesions. Interstitial fibrosis with tubular atrophy and capillary loss are the common manifestations of kidney damage, and tubulo-interstitial lesion is a histological parameter that correlates best of all with kidney function.Conclusions. Among the histological changes in kidneys at hepatorenal syndrome against a background of alcoholic liver cirrhosis, tubulointerstitial lesions are most often found, and closely correlate with the Doppler index of the vascular resistance in the renal arteries.