Nayak Suman Lata, Kumar Manoj, Bihari Chhagan, Rastogi Archana
Department of Nephrology, Institute of Liver and Biliary Sciences, New Delhi, India.
Department of Hepatology and Liver Transplatation, Institute of Liver and Biliary Sciences, New Delhi, India.
J Clin Transl Hepatol. 2017 Jun 28;5(2):92-100. doi: 10.14218/JCTH.2016.00063. Epub 2017 May 4.
The role of bile cast nephropathy (BCN) in pathogenesis of hepatorenal syndrome (HRS) in decompensated cirrhosis and acute on chronic liver failure (ACLF) is unknown. This study aimed to determine the frequency of BCN detected on postmortem renal biopsy among patients with decompensated cirrhosis and ACLF who had been admitted with acute kidney injury due to HRS (HRA-AKI) and expired during that hospitalization. One-hundred-twenty-seven postmortem renal biopsies with adequate size (>1 cm in length) were included for analysis. These were obtained from 84 patients with decompensated cirrhosis and 43 patients with ACLF. BCN was detected in 57 of the total 127 (44.8%) renal biopsy specimens. Patients with BCN had significantly higher levels of serum total bilirubin, total leukocyte count and model for end-stage liver disease score, as compared to those without BCN. BCN was detected in 32/43 (74.4%) of the patients with ACLF, as compared to 25/84 (29.7%) of the patients with decompensated cirrhosis ( < 0.001). On multivariate analysis, direct bilirubin (OR (95% CI): 1.27 (1121-1.698); < 0.001) and presence of ACLF (OR (95% CI): 2.603 (1.054-7.111); = 0.041) were found to be significant predictors of BCN on postmortem renal biopsy. : BCN was found in 72.1% of patients with ACLF and 27.4% patients with decompensated cirrhosis who had been hospitalized with an admitting diagnosis of HRS-AKI and who expired during that hospitalization and underwent postmortem renal biopsy. Direct serum bilirubin and presence of ACLF were found to be significant predictors of BCN on postmortem renal biopsy.
胆汁管型肾病（BCN）在失代偿期肝硬化和慢加急性肝衰竭（ACLF）患者肝肾综合征（HRS）发病机制中的作用尚不清楚。本研究旨在确定因HRS导致急性肾损伤（HRA-AKI）入院且在此次住院期间死亡的失代偿期肝硬化和ACLF患者尸检肾活检中检测到BCN的频率。纳入127例长度大于1 cm的足够大小的尸检肾活检标本进行分析。这些标本取自84例失代偿期肝硬化患者和43例ACLF患者。127例肾活检标本中57例（44.8%）检测到BCN。与未检测到BCN的患者相比，检测到BCN的患者血清总胆红素、白细胞总数和终末期肝病模型评分显著更高。ACLF患者中32/43例（74.4%）检测到BCN，而失代偿期肝硬化患者中25/84例（29.7%）检测到BCN（P<0.001）。多因素分析发现，直接胆红素（比值比（95%可信区间）：1.27（1.121-1.698）；P<0.001）和ACLF的存在（比值比（95%可信区间）：2.603（1.054-7.111）；P=0.041）是尸检肾活检中BCN的显著预测因素。在因HRS-AKI入院且在此次住院期间死亡并接受尸检肾活检的患者中，ACLF患者中72.1%和失代偿期肝硬化患者中27.4%检测到BCN。血清直接胆红素和ACLF的存在是尸检肾活检中BCN的显著预测因素。
