Study on assessment of renal function in chronic liver disease

Abstract

Introduction: Renal dysfunction in chronic liver disease is characterized by impaired natriuresis, decreased free water clearance, and decreased glomerular filtration rate (GFR). Hyponatremia, ascites, and hepatorenal syndrome (HRS) represent the clinical consequences of disturbances in renal function. Optimal management of renal dysfunction in cirrhosis is extremely important in that renal dysfunction frequently complicates the clinical course of advanced liver disease and is invariably associated with poor clinical outcomes. Materials and Methods: This study included patients with chronic liver disease being treated as inpatients in the Department of General Medicine, Alluri Sitarama Raju Academy of Medical Sciences, Eluru from March 2017 to August 2017. Inpatients in the medical ward/ AMCU admitted with chronic liver disease with seemingly normal renal function were included in this analytical study. Lab investigations including complete Liver function test, Renal function tests, viral marker for hepatitis B, Urine analysis, 24 hour urine volume and Urine creatinine was done and results noted. Patients were subjected to an ultrasound scan of abdomen with regard to liver echotexture and size, evidence of splenomegaly or portal hypertension, presence of ascites and kidney pathology.
Results: Age of the patients ranged from a minimum of 22 years to a maximum of 58 years. The mean age was 42.14 years. There was no significant variation in blood urea levels in all the three groups, suggesting that estimation of blood urea will not be of much use in determining renal impairment. In this study mean blood urea level was 22.42 mg/dL. Creatinine clearance calculated at 20-40 ml/min, there are 12 patients (27.90%) calculated by timed creatinine clearance, whereas 4 patients (9.3%) by CGF formula. Creatinine clearance calculated at 60-80 ml/min, there are 5 patients (11.63%) calculated by timed creatinine clearance, where as 17 patients (39.54%) by CGF formula. Creatinine clearance calculated at >80 ml/min, there are 9 patients (20.93%) calculated by timed creatinine clearance, where as 11 patients (25.58%) by CGF formula. Conclusions: In chronic liver disease, serum creatinine alone is not a reliable marker to assess renal dysfunction. Calculating creatinine clearance by using Cockcroft Gault formula overestimates renal function in cirrhotics. Creatinine clearance measured by timed urine collections should be done routinely to assess renal reserve in advanced liver disease. Alcoholism appears to have adverse effect on renal function when compared with other etiologies of cirrhosis