Role of renal dysfunction in development of cirrhosis complications

Abstract

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.

Keywords

• liver cirrhosis
• ascites
• bleeding
• renal dysfunction