Clinical Spectrum of Renal Disorders in Patients with Cirrhosis of Liver

Figures & data

Table 1. Demography of patients with cirrhosis of liver with or without renal disorders

Demography	Patients with cirrhosis (n = 404)	Patients of cirrhosis with renal disorders (n = 178)	Patients of cirrhosis without renal disorders (n = 226)
Mean age in years (±SD)	48.5 (±12.6)	47.7 (±13.3)	48.9 (±12.3)
Sex
Male	319 (79)	137 (77)	182 (80.5)
Female	85 (21)	41 (23)	44 (19.5)
Etiology of cirrhosis
Alcoholism	118 (29.2)	53 (29.8)	65 (28.8)
Hepatitis B	105 (26.0)	43 (24.1)	62 (27.4)
Cryptogenic	92 (22.8)	45 (25.3)	47 (20.8)
Hepatitis C	27 (6.7)	13 (7.3)	14 (6.2)
Alcoholism and hepatitis B	3 (0.7)	2 (1.1)	1 (0.4)
Alcoholism and hepatitis C	1 (0.2)	0 (0.0)	1 (0.4)
Primary biliary	21 (5.2)	9 (5.1)	12 (5.3)
Autoimmune	10 (2.5)	2 (1.1)	8 (3.5)
Nonalcoholic fatty liver disease	24 (5.9)	10 (5.6)	14 (6.2)
Wilson's disease	2 (0.5)	1 (0.5 )	1 (0.4)
Cardiac cirrhosis	1 (0.2)	0 (0.0)	1 (0.4)

Note: The values in parantheses represent percentages.

Table 2. Clinical and laboratory characteristics of cirrhotic patients with renal diseases (n = 178)

Characteristics	Number of cases (%)
Esophageal varices	147 (82.5)
Ascites
Total present	144 (80.9)
Grade 1^a	6 (3.4)
Grade 2	82 (46.1)
Grade 3	56 (31.4)
Splenomegaly	128 (71.9)
Portal vein dilated (>13 mm)	98 (55.0)
Hypoalbuminemia (<3.0 gm/dL)	95 (53.4)
Pedal edema	68 (38.2)
Hepatic encephalopathy	62 (34.8)
Hyponatremia	53 (29.8)
Hematuria	49 (27.5)
Thrombocytopenia	48 (27.0)
Leukocytosis	36 (20.2)
Proteinuria	31 (20.8)
Melena	29 (16.3)
Hepatomegaly	27 (15.2)
Severe anemia (<7.0 gm/dL)	27 (15.2)
Pyuria	26 (14.6)
Shock	18 (10.1)
Hematemesis	15 (8.4)
Duodenal/gastric ulcer	12 (6.7)
Hypertension	12 (6.7)
Type 2 diabetes mellitus	8 (4.5)
Hemorrhoids	6 (3.4)
Leukopenia	3 (1.7)

^aAscites was graded according to International Ascites Club Consensus (Moore et al.).⁸

Figure 1. Spectrum of renal disorders in patients with cirrhosis of liver.

Figure 2. Types of acute kidney injury in patients with cirrhosis of liver.

Table 3. Precipitating factors for acute kidney injury (n = 99)

Etiology of acute kidney injury	Number of cases	Percentage (%)
Prerenal acute kidney injury	36	36.4
Sepsis	5	13.9
Spontaneous bacterial peritonitis	3	8.3
Lower respiratory tract infection	2	5.6
Hypovolemia	29	80.6
Upper GI bleed	15	41.7
Diuretics	8	22.2
Loose motion + diuretics	3	8.3
Septic shock	2	5.6
Loose motion	1	2.8
Nephrotoxic drug	2	5.6
NSAID and aminoglycoside (1 each)
Hepatorenal syndrome	19	19.2
Spontaneous	09	47.4
Precipitating factors	10	52.6
Spontaneous bacterial peritonitis	4	21.1
Upper GI bleed	2	10.5
Sepsis, diuretics, loose motion, paracentesis (one each)	4	21.0
Acute tubular necrosis	44	44.4
Sepsis	27	61.4
Spontaneous bacterial peritonitis	15	34.1
UTI	8	18.2
Spontaneous bacterial peritonitis + UTI	3	6.8
Cellulitis/abscess	1	2.3
Hypovolemia	16	36.4
UGI bleed with shock	12	27.3
Septic shock	4	9.1
Nephrotoxic drug (aminoglycoside)	1	2.3

Note: NSAID - Non-Steroidal Anti-inflammatory Drugs; UTI - urinary tract infection.

Table 4. Impact of renal diseases on mortality of patients with cirrhosis based on Child–Pugh classification

Child–Pugh class	Patients with cirrhosis (n = 404)	Patients of cirrhosis with renal disorders (n = 178)	Patients of cirrhosis without renal disorders (n = 226)	p-Value
Class A
Mortality (%)	1 (1.1)	0 (0.0)	1 (1.2)	NS
No mortality (%)	94 (98.9)	15 (100.0)	79 (98.8)
Class B
Mortality (%)	33 (24.6)	19 (28.3)	14 (20.9)	NS
No mortality (%)	101 (75.4)	48 (71.7)	53 (79.1)
Class C
Mortality (%)	117 (66.9)	75 (78.1)	42 (53.2)	<0.001
No mortality (%)	58 (33.1)	21 (21.9)	37 (46.8)

Note: NS - Non-significant.

Moore KP, Wong F, Gines P, The management of ascites in cirrhosis: Report on consensus conference of the International Ascites Club. Hepatology. 2003;38:258–266.

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