Role of renal dysfunction in development of cirrhosis complications
DOI:
https://doi.org/10.14739/2310-1210.2014.2.25425Keywords:
liver cirrhosis, ascites, bleeding, renal dysfunctionAbstract
Renal dysfunction is defined as progressing renal failure against chronic and acute failure of a liver at insignificant or total absence of morphological changes in kidneys. Emergence of renal dysfunction at cirrhosis is an integral part of a natural course of the disease characterizing its weight. However the importance of renal dysfunction in development of complications of cirrhosis and its correction today fully are not defined.
The aim of research. To estimate the role of renal dysfunction in development of complications of cirrhosis.
Materials and methods. 70 patients with cirrhosis took part in the study. 34 patients were hospitalized with ascites resistant to the diuretics and 36 patients had bleeding from esophageal varices. 29 patients have died. Duration of supervision of patients was from 2-3 weeks to 1,5-2 years. All patients had numerous clinical, laboratory and instrumental researches. They included measurement of a daily diuresis, body weight, abdominal circumference. Laboratory researches included, in addition to standard, definition of a creatinine, sodium and potassium level in blood and urine, speeds of a glomerular filtration (GFR). Ultrasonic research (US) of abdominal organs with vessels of an abdominal cavity and renal arteries color duplex scan. Diameter of renal arteries, speed of blood-groove on them and an index of resistance of arteries were estimated. Data of instrumental and laboratory researches were compared with clinical characteristics of a course of a disease and existence of complications.
Results. In 14 (39%) patients with bleeding and 28 (82%) with ascites before development of complications the negative water balance – decrease diuresis in comparison with amount of the drunk liquid was noted at the corresponding diuretic therapy that is an early clinical sign of development of renal dysfunction. At laboratory inspection in all patients before hospitalization the tendency to GFR decrease was noted. At an ultrasonic exam of renal arteries resistance index exceeded normal ranges (0,6-0,7) and was 0,95±0,03. In the absence of correction of renal dysfunction the unsatisfactory results of treatment consisting in frequent recurrence of bleeding and high mortality are noted.
Conclusions. Clinical manifestation of renal dysfunction is the negative water balance; the laboratory – a tendency to speed of a glomerular filtration decrease; the tool – reduction of diameter of renal arteries, decrease in a volume blood-groove in them, increase in an index of resistance in process of transition from the disease not complicated to the complicated current that took place in 76% of patients. In 82% patients with ascites and 39% with bleeding from esophageal varices clinically significant renal dysfunction took place before development of complications. More than for 60% of patients with early recurrence of bleeding the gepatorenal syndrome was diagnosed. At all died patients hepato-renal insufficiency was noted.
References
Fedosyna E.A., Maevskaya M.V., Ivashkin V.T. Principles of therapy of portal hypertensia at patients with cirrhosis. RZhGGP 2012; 5: 11-14.
Zavgorodnyi S.N., Tugushev A.S., Mikhantyev D. I. Diagnostika, lechenie i prophilaktika pochechnoi disfunktsii pri tsirroze pechtns [Diagnostics, treatment and prevention of renal dysfunction at cirrhosis]. Methodical recommendations of MOZ Ukraine, 2013.- Kiev, 36 p.
Paolo Angeli, Arun Sanyal, Soren Moller, Carlo Alessandria, Adrian Gadano, Ray Kim, Shiv K. Sarin and Mauro Bernardi. A new method for therapeutic paracentesis: The automated low flow pump system. Comments in the context of the history of paracentesis. J Hepathology 2013; 58(5): 850-852.
Arroyo V. A new method for therapeutic paracentesis: The automated low flow pump system. Comments in the context of the history of paracentesis. J Hepathology 2013; 58(5): 850-852.
Claudia Fagundes, Rogelio Barreto, Mónica Guevara, Elisabet Garcia, Elsa Solà, Ezequiel Rodríguez, Isabel Graupera. A modified acute kidney injury classification for diagnosis and risk stratification of impairment of kidney function in cirrhosis. J Hepathology 2013; 59(3): 474-481.
Francoz C., Glotz D., Moreau R., Durand F. The evaluation of renal function and disease in patients with cirrhosis. J Hepatology 2010; 52(4): 605-613.
Gines P., Schrier R.W. Renal failure in cirrhosis. N Engl J Med 2009; 361(13): 1279-1290.
Mónica Guevara, María E. Baccaro, Jose Ríos, Marta Martín-Llahí, Juan Uriz, Luis Ruiz del Arbol, Ramón Planas, Alberto Monescillo, Carlos Guarner, Javier Crespo, Rafael Bañares, Vicente Arroyo and Pere Ginès. Risk factors for hepatic encephalopathy in patients with cirrhosis and refractory ascites: relevance of serum sodium concentration. Liver International 2010; 30(8): 1137-1142.
Suman Lata Nayak, Rakhi Maiwall, Ashish Nandwani, Sivaramakrishnan Ramanarayanan, R. P. Mathur, Ramesh Kumar, S. K. Sarin. Management of acute kidney injury in cirrhosis. Hepatology International 2013; 7(3); 813-819.
Naro Ohashi, Naoko Tsuji, Yoshitaka Naito, Takamasa Iwakura, Shinsuke Isobe, Masafumi Ono, Tomoyuki Fujikura, Takayuki Tsuji, Yukitoshi Sakao. Relationship between urinary fractional excretion of sodium and life prognosis in liver cirrhosis patients. Hepatology Research 2013; 43(11): 1156-1162.
Marco Di Pascoli, Francesca Zampieri, Santina Quarta, David Sacerdoti, Carlo Merkel, Angelo Gatta, Massimo Bolognesi. Heme oxygenase regulates renal arterial resistance and sodium excretion in cirrhotic rats. J Hepatology 2011; 54(2): 258-264.
Salerno F., Cazzaniga M., Merli M. Diagnosis, treatment and survival of patients with hepatorenal syndrome: A survey on daily medical practice. J Hepatology 2011; 55(6): 1241-1248.
Umgelter A., Reindl W., Franzen M. Renal resistive index and renal function before and after paracentesis in patients with hepatorenal syndrome and tense ascites. Intensive Care Med 2009; 35: 152-156.
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