Iqbal Jawaid, Khalid Muhammad Ali, Hanif Farina M, Mandhwani Rajesh, Laeeq Syed Mudassir, Majid Zain, Luck Nasir Hassan
Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
J Transl Int Med. 2018 Dec 31;6(4):181-184. doi: 10.2478/jtim-2018-0033. eCollection 2018 Dec.
Renal dysfunction is one of the dreaded complications of cirrhosis. MELD is a validated chronic liver disease (CLD) severity scoring system. Urinary (U) Na/K ratio closely correlates with renal dysfunction in terms of low GFR in cirrhotic patients.
All consecutive patients with decompensated cirrhosis between the age of 18 to 70 years, of either gender, presenting in the outpatients' department of Sindh Institute of Urology and Transplantation, Karachi, from June 2015 to June 2017 were included. The MELD score was calculated and the UNa/K ratio less than 1 was taken as surrogate marker of renal dysfunction. Statistical analysis was performed by SPSS (version 20.0).
A total of 71 patients were enrolled. The mean age was 43.79 years and majority were male (67.6%). The most common cause of liver cirrhosis was HCV, found in 42 (59.2%) patients. The mean CTP score was 10.48 ± 2.069 (range: 6-14) with majority of the patients following in class C, that is, 48 (67.6%). Mean MELD score was 21.75 ± 8.96 (range: 8-43). In 57 patients (80.3%), MELD score was > 15.The mean serum creatinine and mean serum sodium were 1.5 ± 1.1 mg/dl (range: 0.37-5.3) and 133.79 ± 6.9 mmol/L (range: 112-152), respectively. Mean urinary sodium and urinary potassium were 38.60 ± 46.64 mmol/L (range: 5-181) and 38.15 ± 23.9 mmol/L (range: 4.3-112), respectively. In majority of study population, UNa/K ratio was below 1, that is, in 52 patients (73.2%). Statistically significant correlation was documented between MELD score and UNa/K ratio (ɤ = 0.34, = 0.004).
The inverse correlation between MELD scores and UNa/K ratio indicates that patients with CLD and higher MELD scores might have renal dysfunction. This finding however should be corroborated by large scale studies.
肾功能不全是肝硬化可怕的并发症之一。终末期肝病模型（MELD）是一个经过验证的慢性肝病（CLD）严重程度评分系统。在肝硬化患者中，尿钠/钾比值（U Na/K）与低肾小球滤过率（GFR）所致的肾功能不全密切相关。
纳入2015年6月至2017年6月在卡拉奇信德泌尿与移植研究所门诊就诊的所有年龄在18至70岁之间、性别不限的失代偿期肝硬化连续患者。计算MELD评分，将尿钠/钾比值小于1作为肾功能不全的替代指标。采用SPSS（20.0版）进行统计分析。
共纳入71例患者。平均年龄为43.79岁，大多数为男性（67.6%）。肝硬化最常见的病因是丙型肝炎病毒（HCV），42例（59.2%）患者中发现该病因。平均Child-Turcotte-Pugh（CTP）评分为10.48±2.069（范围：6 - 14），大多数患者属于C级，即48例（67.6%）。平均MELD评分为21.75±8.96（范围：8 - 43）。57例患者（80.3%）的MELD评分>15。平均血清肌酐和平均血清钠分别为1.5±1.1mg/dl（范围：0.37 - 5.3）和133.79±6.9mmol/L（范围：112 - 152）。平均尿钠和尿钾分别为38.60±46.64mmol/L（范围：5 - 181）和38.15±23.9mmol/L（范围：4.3 - 112）。在大多数研究人群中，尿钠/钾比值低于1，即52例患者（73.2%）。MELD评分与尿钠/钾比值之间存在统计学显著相关性（ɤ = 0.34，P = 0.004）。
MELD评分与尿钠/钾比值之间的负相关表明，CLD患者且MELD评分较高者可能存在肾功能不全。然而，这一发现应通过大规模研究加以证实。
