Sural S, Sharma R K, Gupta A, Sharma A P, Gulati S
Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Ren Fail. 2000;22(5):623-34. doi: 10.1081/jdi-100100903.
Acute renal failure (ARF) associated with liver disease is a commonly encountered clinical problem of varied etiology and high mortality. We have prospectively analyzed patients with liver disease and ARF to determine the etiology, clinical spectrum, prognosis and factors affecting the outcome. Other than hepatorenal syndrome patients, out of 221 cases, 66 developed ARF secondary to various liver disease like cirrhosis (n = 29, mortality 8, risk factors-older age p < 0.01, grade III/IV encephalopathy p < 0.05), fulminant hepatic failure (n = 25, mortality 15, risk factor-prolonged prothrombin time p < 0.01), and obstructive jaundice (n = 12, mortality 7, risk factor-sepsis p < 0.01). In these three groups the factors leading to ARF were volume depletion (24), gastrointestinal bleed (28), sepsis (34), drugs (27) [aminoglycosides (9) and NSAID (18)] along with hyperbilirubinemia. Various types of ARF with contemporaneous liver injury were malaria (n = 37, mortality 15, risk factors-higher bilirubin p < 0.001, higher creatinine p < 0.05, anuria p < 0.05 and dialysis dependency p < 0.05), sepsis (n = 36, mortality 22, risk factors-age p < 0.001, higher bilirubin p < 0.01, oliguria p < 0.05), hypovolemia with ischemic hepatic injury (n = 14, mortality 5, risk factors-higher creatinine p < 0.05 and SGPT p < 0.01), acute pancreatitis (n = 12, mortality 4, risk factors-higher bilirubin p < 0.001, higher SGPT p < 0.01, dialysis dependency p < 0.05), rifampicin toxicity (n = 10, no mortality), paroxysmal nocturnal hemoglobinuria (n = 3, no mortality), CuSO4 poisoning (n = 3 mortality 2), post abortal (n = 11, mortality 6, risk factors higher creatinine p < 0.05 and SGPT p < 0.01), ARF following delivery including HELLP syndrome (n = 12, mortality 4, risk factors-higher bilirubin p < 0.01 and SGPT p < 0.01), and of uncertain etiology (n= 14 mortality 4). 133 patients (60.2%), required hemodialysis hemodialfiltration or peritoneal dialysis. ARF associated with liver disease is having high mortality (42.5%). Avoidance of dehydration, hypotension, nephrotoxic drugs and sepsis, with promote dialytic support are necessary to reduce mortality and morbidity.
与肝病相关的急性肾衰竭（ARF）是临床上常见的问题，病因多样，死亡率高。我们对患有肝病和ARF的患者进行了前瞻性分析，以确定病因、临床谱、预后以及影响结局的因素。除肝肾综合征患者外，在221例病例中，66例继发于各种肝病，如肝硬化（n = 29，死亡率8例，危险因素为年龄较大p < 0.01，III/IV级脑病p < 0.05）、暴发性肝衰竭（n = 25，死亡率15例，危险因素为凝血酶原时间延长p < 0.01）和梗阻性黄疸（n = 12，死亡率7例，危险因素为败血症p < 0.01）。在这三组中，导致ARF的因素包括容量耗竭（24例）、胃肠道出血（28例）、败血症（34例）、药物（27例）[氨基糖苷类（9例）和非甾体抗炎药（18例）]以及高胆红素血症。伴有同期肝损伤的各种类型的ARF包括疟疾（n = 37，死亡率15例，危险因素为胆红素升高p < 0.001、肌酐升高p < 0.05、无尿p < 0.05和依赖透析p < 0.05）、败血症（n = 36，死亡率22例，危险因素为年龄p < 0.001、胆红素升高p < 0.01、少尿p < 0.05）、低血容量伴缺血性肝损伤（n = 14，死亡率5例，危险因素为肌酐升高p < 0.05和谷丙转氨酶p < 0.01）、急性胰腺炎（n = 12，死亡率4例，危险因素为胆红素升高p < 0.001、谷丙转氨酶升高p < 0.01、依赖透析p < 0.05）、利福平毒性（n = 10，无死亡病例）、阵发性夜间血红蛋白尿（n = 3，无死亡病例）、硫酸铜中毒（n = 3，死亡率2例）、流产后（n = 11，死亡率6例，危险因素为肌酐升高p < 0.05和谷丙转氨酶p < 0.01）、分娩后ARF包括HELLP综合征（n = 12，死亡率4例，危险因素为胆红素升高p < 0.01和谷丙转氨酶p < 0.01）以及病因不明（n = 14，死亡率4例）。133例患者（60.2%）需要血液透析、血液透析滤过或腹膜透析。与肝病相关的ARF死亡率很高（42.5%）。避免脱水、低血压、肾毒性药物和败血症，并加强透析支持，对于降低死亡率和发病率是必要的。
