A Hospital Based Prospective Study to Find Out Etiology of Chronic Liver Disease Has a Bearing on Renal Dysfunction

Abstract

Background: Detection of renal insufficiency is clinically important because it contributes significantly to high morbidity and mortality in cirrhosis. Patients with cirrhosis and renal failure are at high risk for death while awaiting transplantation and have an increased frequency of complications and reduced survival after transplantation, as compared with those without renal failure. The aim of this study to find out etiology of chronic liver disease has a bearing on renal dysfunction.Materials & Methods: The prospective study done on 50 patients admitted with chronic liver disease with seemingly normal renal function in department of Medicine at Shree Kalyan Government Medical College, Sikar, Rajasthan during one year period. The patients included with evidence for chronic liver disease being defined by a compatible Clinical profile along with Biochemical or Sonographic evidence OR Tissue diagnosis. Renal function was assessed by serum creatinine, creatinine clearance from timed urine collection [(UxV)/P] and creatinine clearance by Cockcroft Gault formula (CGF).Results: Our study showed that the mean value of age was 45.16 years. Of the patients included 40 were males, while remaining 10 were females. 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. Serum creatinine levels failed to rise above 1.2 mg/dL, suggesting that moderate to severe renal dysfunction may be masked by seemingly normal creatinine levels. Patients with greater amount of renal impairment were found to have lesser urine output, thus suggesting that eliciting history of oliguria in a patient with normal serum creatinine levels should call for a high index of suspicion of renal dysfunction. Measurement of creatinine clearance using the Cockcroft Gault formula (CGF) showed significantly higher values, suggesting overestimation of GFR by this method.Conclusion: We concluded that renal dysfunction in advanced liver disease, routine tests like blood urea and serum creatinine will be insufficient. Other methods like measured creatinine clearance should be employed to get an accurate picture of the renal status.