Saxena Disha, Yadav Manoj, Kumar Tarun, Sharma Sanjeev, Beniwal Pankaj, Malhotra Vinay, Agarwal Dhananjai, Nijhawan Sandeep
Department of Nephrology, SMS Medical College and Hospital, Jaipur, Rajasthan, India.
Department of Gastroenterology, SMS Medical College and Hospital, Jaipur, Rajasthan, India.
Indian J Nephrol. 2024 Jul-Aug;34(4):317-322. doi: 10.25259/ijn_286_23. Epub 2024 May 14.
Patients with cirrhosis are susceptible to development of acute kidney injury (AKI), which leads to poor outcome. We conducted a study to evaluate the spectrum of AKI in patients with cirrhosis.
This study was conducted in consecutive cirrhotic patients with AKI admitted in a tertiary care center of India from April 2020 to December 2022. Details including history, examination findings, and results of laboratory investigations were recorded.
A total of 243 patients were enrolled in this study. The majority (91.3%) of the patients were males. The most common etiology of cirrhosis was alcohol in 58.4% ( = 142) followed by hepatitis B in 10.3% ( = 25) of patients. Pre-renal form of AKI was present in 54.4% ( = 132) of patients and hepatorenal syndrome (HRS) in 21.8% ( = 53) of patients. IgA nephropathy was the commonest ( = 6) glomerular pathology in nonresponders with intrinsic renal disease. Majority of the patients belonged to stage II (46.9%) and stage I AKI (37%), while only 16.1% had stage III AKI. Various stages of AKI showed a significant correlation ( < 0.05) with Child-Turcotte-Pugh (CTP) score and Model for End-stage Liver Disease (MELD)-Na score. The overall in-hospital mortality rate was found to be 18.5% ( = 45).
Renal dysfunction is a frequent complication among cirrhotic patients. Pre-renal factors were the most common cause of AKI in cirrhotics. Stages of AKI showed significant correlation with liver prognostic scores. Renal biopsy should be considered in patients not responding to treatment, to guide further management.
肝硬化患者易发生急性肾损伤（AKI），这会导致不良预后。我们开展了一项研究以评估肝硬化患者中AKI的情况。
本研究纳入了2020年4月至2022年12月在印度一家三级医疗中心收治的连续性肝硬化合并AKI患者。记录了包括病史、检查结果及实验室检查结果等详细信息。
本研究共纳入243例患者。大多数患者（91.3%）为男性。肝硬化最常见的病因是酒精，占58.4%（n = 142），其次是乙型肝炎，占10.3%（n = 25）。54.4%（n = 132）的患者存在肾前性AKI，21.8%（n = 53）的患者存在肝肾综合征（HRS）。在患有内在性肾病的无反应者中，IgA肾病是最常见的（n = 6）肾小球病变。大多数患者属于II期（46.9%）和I期AKI（37%），而只有16.1%的患者为III期AKI。AKI的各个阶段与Child-Turcotte-Pugh（CTP）评分和终末期肝病模型（MELD）-Na评分均呈显著相关（P < 0.05）。发现总体院内死亡率为18.5%（n = 45）。
肾功能不全是肝硬化患者常见的并发症。肾前性因素是肝硬化患者AKI最常见的原因。AKI的阶段与肝脏预后评分呈显著相关。对于治疗无反应的患者应考虑进行肾活检，以指导进一步的管理。
