Study of clinical and laboratory profile in alcoholic liver disease with emphasis on renal function

Swati Hegde, Arun Vishnar, Girish B. Ramteke

Abstract


Background: Alcoholic liver disease is a major health care problem in India and accounts for increased economic burden. Chronic liver disease is most commonly complicated with renal dysfunction and this combination leads to significant morbidity and mortality. The aim was to study the clinical and laboratory profile and evaluation of renal function in alcoholic liver disease.

Methods: Sixty consecutive patients presenting to a tertiary care hospital in central India with alcoholic liver disease were studied and their clinical and laboratory investigation noted and analysed.

Results: The mean age at presentation was 45.18years. Fifty nine of them were male. Abdominal distension and jaundice were the most common presenting complaint. Fourteen (23%) patients presented with complications. Twenty six (43%) had severe anemia, 16 (27%) had thrombocytopenia and 23 (38.3%) had coagulopathy. The mean AST, ALT, bilirubin, ALP and albumin were 113.51 U/l, 62.16 U/l, 5.78 mg/dl, 211 U/l and 3.12 gm/dl respectively. On abdominal sonography fatty changes was seen in 20 (33%), Hepatomegaly in 20 (33%), Splenomegaly in 25 (41%) and PVD ≥13 mm in 11 (21%). The prevalence of renal dysfunction on the basis of reduced GFR was 30% which included all forms of renal failure in chronic liver disease. Serum creatinine level was increased in 20% of the patients. Blood urea was raised in 37%.

Conclusion: The results of this study established most of the known facts about alcoholic liver disease in this part of the world. Not only liver function tests, patients with alcoholic liver disease have abnormal haematological and renal function too. Renal dysfunction was seen in significant number of patients.

 


Keywords


Alcoholic liver disease, Clinical profile, Renal function

Full Text:

PDF

References


Mark E. Mailiard, Michael F. Sorrel. Alcoholic liver disease. In: Mark E. Mailiard, Michael F. Sorrel, eds. Harrison’s Principles of Internal Medicine. 18th ed. New York: McGraw-Hill; 2012: 2589-2591.

Lefkowitch JH. Morphology of alcoholic liver disease. Clin Liver Dis. 2005;9:37-53.

Yip WW, Burt AD. Alcoholic liver disease. Semin Diagn Pathol. 2006;23:149-60.

Ginès P, Cárdenas A, Schrier RW. Liver disease and the kidney. In: Schrier RW, eds. Diseases of the kidney and urinary tract. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2007: 2179-2205.

Arroyo V, Ginès P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. Hepatology. 1996;23:164-76.

Martin PY, Ginès P, Schrier RW. Nitric oxide as a mediator of hemodynamic abnormalities and sodium and water retention in cirrhosis. N Engl J Med. 1998;339:533-41.

Sherman DS, Fish DN, Тeitelbaum I. Assessing renal function in cirrhotic patients: problems and pitfalls. Am J Kidney Dis. 2003;41:269-78.

McCullough AJ, O’Connor JF. Alcoholic liver disease: proposed recommendations for the American college of gastroenterology. Am J Gastroenterol. 1998;93:2022-36.

Frerichs FT. Tratado practico de las Enfermedades del Hígado, de los Vasos Hepaticos y de las Vias Biliares. Madrid: Libreria Extranjera y Nacional, cientifíca y Literaria; 1877.

Flint A. Clinical report on hydro-peritoneum based on an analysis of forty-six cases. Am J Med Sci. 1863;45:306-39.

Hecker R, Sherlock S. Electrolyte and circulatory changes in terminal liver failure. Lancet. 1956;2:1221-5.

Koppel MH, Coburn JN, Mims MM, Goldstein H, Boyle JD, Rubini ME. Transplantation of cadaveric kidneys from patients with hepatorenal syndrome. Evidence for the functional nature of renal failure in advanced liver disease. N Engl J Med. 1969;280:1367-71.

Iwatsuki S, Popovtzer MM, Corman JL, Ishikawa M, Putnam CW, Katz FH, et al. Recovery from hepatorenal syndrome after orthotopic liver transplantation. N Engl J Med. 1973;289:1155-9.

Schroeder ET, Shear L, Sancetta SM, Gabuzda GJ. Renal failure in patients with cirrhosis of the liver. III Evaluation of intrarenal blood flow by paraaminohippurate extraction and response to angiotensin. Am J Med. 1967;43:887-96.

Epstein M, Berk DP, Hollenberg NK, Adams DF, Chalmers TC, Abrams HL, et al. Renal failure in the patient with cirrhosis. The role of active vasoconstriction. Am J Med. 1970;49:175-85.

Suthar HN, Suthar KD, Mewada BN. Clinical profile of cases of alcoholic liver disease. Int J Med Sci Public Health. 2013;2:394-8.

Sarin SK, Dhingra N, Bansal A, Malhotra S, Guptan RC. Dietary and nutritional abnormalities in alcoholic liver disease: a comparison with chronic alcoholics without liver disease. Am J Gastroenterol. 1997;92(5):777-83.

Pathak OK, Paudel R, Panta OB, Giri BR, Adhikari B. Retrospective study of clinical profile and prognostic indicators in patients of alcoholic liver disease admitted to a tertiary care teaching hospital in western Nepal. Saudi J Gastroenterol. 2009;15(3):172-5.

Mendenhall CL. Alcoholic hepatitis. Clin Gastroenterol. 1981;10:417-41.

Sherman DS, Fish DN, Тeitelbaum I. Assessing renal function in cirrhotic patients: problems and pitfalls. Am J Kidney Dis. 2003;41:269-78.