A Study Of Acute Renal Faılure In Patıents Wıth Cırrhosıs Of Liver For Evaluatıon Of Causes,Treatment And Prognosıs: A Prospecto-Retrospectıve Study

Context: Patients with advanced cirrhosis commonly have reduced renal function. Renal failure is frequently related to cirrhosis and renal function is often compromised as a secondary consequence of heaptic failure, independent of etiology of cirrhosis, which is called the functional renal failure or hepatorenalsyndrome (HRS). Aims:To evaluate the causes of ARF in patients with cirrhosis of liver of any etiology and to study the outcome of treatment and prognosis of ARF in patients with cirrhosis of liver of any etiology. Setting and design: Hospital based prospecto-retrospective study, an evaluation of the causes (types) of acute renal failure in patients with cirrhosis, treatment of acute renal failure and its prognosis was done. Materials and Methods: The patients were selected from the gastroenterology and Nephrology unit Christian Medical College & Hospital, Ludhiana. It included all patients admitted in wards who were diagnosed to have cirrhosis of any etiology complicated by renal insufficiency. A total of 131patients were included, 61 prospective and 70 retrospective. Results: Out of 131 patients, 51 (38.93%) had pre-renal ARF, 20 in the prospective group, and 31 in the retrospective group. The average age of patients in the study was 49.87+/-10.10 years. The mortality rate was maximum in the age group of 40 to 49 years. HRS was diagnosed in 44 patients (33.54%),of whom, 30 had HRS type1 and 14 had HRS type 2. ATN was seen in 36 patients (27.48%). FENa was found to be a good predictor of pre-renal ARF and ATN, however, it was not found to be very useful as a predictor of HRS in this study. Haemodialysis was done on 36 patients. Only 38 of the 131 patients had an improvement in the renal function. Of these, 25 had pre-renal ARF, 11 had HRS type2, one had HRS type1 and another one had ATN. In 43 patients, ARF was associated with upper gastrointestinal haemorrhage, of which 29 (67.44%) died. Conclusion: About 35% of these patients have HRS, 40% have prerenal ARF and 25% have acute tubular nercrosis. An intravascular volume expansion should be given to all patients of ARF with cirrhosis except to those with fluid overload. Reversal of HRS is seen in a high proporation of patients treated with Terliperssin. There is a high mortality associated with these patients, especially so with HRS type1 and ATN.