Yaşar Bülent, Akbayir Nihat, Celik Selda, Ozgil Demet, Akkan Züleyha, Yildiz Kürşat, Yildirim Yaşar
Haydarpaşa Numune Hospital, Department of 1 st Internal Medicine, Istanbul.
Turk J Gastroenterol. 2002 Sep;13(3):164-7.
Acute renal failure is a very rare complication seen during the course of non- fulminant hepatitis A. Several mechanisms have been postulated in the pathogenesis of renal failure. Firstly, there is insufficiency of renal blood flow due to developing endotoxemia or cryoglobulinemia, secondly mesangial proliferative glomerulonephritis or interstitial nephritis occurs due to immune complexes and finally there is acute tubular necrosis caused by the direct cytopathic effect of the virus or due to immune complexes. The following case report describes a 17 year old male patient admitted with complaints of appetite loss and severe weight loss due to anorexia nervosa. During the second week of admission, he developed hepatitis A infection which was complicated by acute renal failure requiring hemodialysis therapy. Hepatorenal parameters returned to normal values by the fifth week of admission in this case of biopsy proven acute tubular necrosis. In this case, the possible negative effects of malnutrition on the liver and kidneys were not observed. The present authors emphasize that during the course of non- fulminant hepatitis A, renal functions should be closely monitored and renal biopsy should be performed if acute renal failure occurs.
急性肾衰竭是无暴发性甲型肝炎病程中一种非常罕见的并发症。肾衰竭的发病机制有多种假说。首先，由于内毒素血症或冷球蛋白血症的发生导致肾血流量不足；其次，免疫复合物会引发系膜增生性肾小球肾炎或间质性肾炎；最后，病毒的直接细胞病变效应或免疫复合物会导致急性肾小管坏死。以下病例报告描述了一名17岁男性患者，因神经性厌食症出现食欲减退和严重体重减轻而入院。入院第二周，他感染了甲型肝炎，并并发急性肾衰竭，需要进行血液透析治疗。在这例经活检证实为急性肾小管坏死的病例中，肝肾参数在入院第五周恢复到正常水平。在该病例中，未观察到营养不良对肝脏和肾脏可能产生的负面影响。本文作者强调，在无暴发性甲型肝炎病程中，应密切监测肾功能，若发生急性肾衰竭，应进行肾活检。
