Published: 2016-12-27

The spectrum of renal changes in patients with liver diseases: an immunofluorescent and light microscopic study

Gireesh K. Bhasin, Shweta Rana, Kanchan Bhasin


Background: There are divergent observations on renal function tests and renal morphology in patients with liver diseases. The present study was designed (1) To study the morphological changes in kidney in patients with various types of Liver diseases; (2) To study the correlation between the renal histology, clinical and other laboratory parameters in these cases; (3) To suggest the possible mechanisms of renal injury secondary to liver diseases.

Methods: This prospective study was carried out at the department of pathology of a tertiary care centre in Delhi. A total of 30 patients admitted with liver diseases were included in the study. All kidney samples were evaluated by light microscopy and immunofluorescence microscopy. The sections were stained by fluorescent labeled antisera for human IgG, IgA and IgM. Postmortem kidney biopsy from 10 patients dying of unrelated diseases served as controls.

Results: Glomerular changes on light microscopy were present in twenty four patients (80%) as compared to two controls (20%). The difference was statistically significant (x2= 11.75; p<0.001). Nine out of 13 patients with severe impairment of liver function tests (LFTs) showed specific glomerulopathies whereas only one out of 17 patients with mild to moderate impairment of LFTs, showed specific glomerular lesion. It was found to be statistically significant (x2= 13.4; p<0.001). Immunofluorescent study showed the presence of immune deposits in 21 out of 30 patients (70%). IgA positivity was seen in 18 cases, IgG in 9 cases and IgM in 10 cases.

Conclusions: There is a wide spectrum of morphological lesions in the kidney in patients with liver diseases. These were mainly glomerular lesions and were directly related to the severity and chronicity of liver diseases. Immune deposits were commonly present in patients with chronic liver disease.



Chronic liver disease, Cirrhosis, Glomerular lesions, Immunofluorescence

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Solomon P. The role of the kidney in Laennec’s cirrhosis of the Liver. Medicine. 1958;37(4):299-316.

Bloodworth JM, Sommers SC. Cirrhotic glomerulosclerosis: a renal lesion associated with hepatic cirrhosis. Lab invest. 1959;8:962-5.

Sakaguchi H, Dachs S, Grisman E, Paronetto F, Solomon M, Churg J. Hepatic glomerulosclerosis: An electron microscopic study of renal biopsies in liver diseases. Lab Invest. 1965;14:533-41.

Berger J, Yaneva H, Nabarra B. Glomerular changes in patients with cirrhosis of Liver. Adv Nephrol Necker Hosp. 1977;7:3-14.

Callard P, Feldmann G, Prandi D, Belair MF, Mandet C, Weiss Y. Immune complex type glomerulonephritis in cirrhosis of the liver. Am J Pathol. 1975;80(2):329-40.

Newell GC. Cirrhotic Glomerulonephritis: Incidence, Morphology, Clinical Features and Pathogenesis. Am J Kidney Diseases. 1987;9(3):183-90.

Nochy D, Callard P, Bellon B, Bariety J, Druet P. Association of overt glomerulonephritis and liver disease: a study of 34 patients. Clin Nephrol. 1976;6(4):422-7.

Fukuda Y. Renal glomerular changes associated with liver diseases. Acta Pathol Jpn. 1982;32(4):561-74.

Combes B, Shorey J, Stastny P, Eigenbrodt EH, Hull AR, Carter NW. Glomerulonephritis with deposition of Australia antigen- antibody complexes in glomerular basement membrane. Lancet. 1971;2(7718):234-7.

Lai KN, Lai FM, Chan KW. The clinic- pathological features of hepatitis B virus associated glomerulonephritis. Q.J. Med. 1987;63:323-3.

Johnson RJ, Couser WG. Hepatitis B infection and renal disease. Clinical immunopathogenetic and therapeutic considerations. Kidney Int. 1990;37:663-76.

Fisher ER, Hellstrom HR. The membranous and proliferative glomerulonephritis of hepatic cirrhosis. Am J Clin Path. 1959;32(1):48-55.

Jones WA, Rao GDR, Brunstein H. The renal glomerulus in cirrhosis of Liver. Am J Pathol. 1961;39:393-404.

Dash SC, Bhowmik D. Glomerulopathy with Liver Disease: Patterns and management. Saudi J Kidney Dis Transplant. 2000;11(3):414-20.

Trawale JM, Paradis V, Routou PE, Francoz C, Escolano S, Sallee M. The spectrum of renal lesions in patients with cirrhosis: a clinicopathological study. Liver Int. 2010;30(5):725-32.

Noel LH, Droz D, Gascon M, Berger J. Primary IgA nephropathy from the first described cases to the present. Semin Nephrol. 1987;7:351-4.

Kawaguchi K, Koike M. Glomerular lesions associated with liver cirrhosis: an immunohistochemical and clinicopathologic analysis. Hum Pathol. 1986;17(11):1137-43.

Morzycka M, Slusarczyk J. Kidney glomerular pathology in various forms of acute and chronic hepatitis. Arch Pathol Lab Med. 1979;103:38-41.

Sakaguchi H. Hepatic glomerulosclerosis-Light microscopic study of autopsy cases. Acta Pathol Jpn. 1968;18(4):407-15.

Nakamoto Y, Lida H, Kobayashi K, Dohi K, Kida H, Hattori N, et al. Hepatic glomerulonephritis characteristic of hepatic IgA glomerulonephritis as the major part. Virchows Arch A Pathol Anat Histol. 1981;392(1):45-54.

Patek AJ, Seegal D, Bevans M. The coexistence of cirrhosis of the liver and glomerulonephritis. Am J Med Sci. 1951;221(1):77-85.

Knieser MR, Jenis EH, Lowenthal DT, Bancroft WH, Burns W, Salhoub R. Pathogenesis of renal disease associated with viral hepatitis. Arch Pathol. 1974;97(4):193-200.

Kohler PF, Cronin RE, Hammond WS, Olin D, Carr RI. Chronic membranous glomerulonephritis caused by hepatitis B antigen- antibody immune complexes. Ann Intern Med. 1974;81(4):448-51.

Takekoshi Y, Shida N, Saheki Y, Tanaka M, Satake Y, Matsumoto S. Strong association between membranous nephropathy and hepatitis B surface antigenemia in Japanese children. Lancet. 1978;2:1065-8.

Mistilis SP, Blackburn CR. Active chronic hepatitis. Am J Med. 1970;48(4):484-95.

Bridi GS, Falcon PW, Brackett NC, Still WJ, Sporn IN. Glomerulonephritis and renal tubular acidosis in a case of chronic active hepatitis with hyperimmunoglobulinemia. Am J Med. 1972;52(2):267-78.

Myers BD, Griffel B, Navch D, Jankielowiiz T, Klajman A. Membranoproliferative glomerulonephritis associated with persistent viral hepatitis. Am J Clin Pathol. 1973;60(20):222-8.

Brzosko WJ, Nazarewicz T, Krawczynski K, Morzycka M, Nowoslawski A. Glomerulonephritis associated with Hepatitis – B surface antigen immune complexes in children. The Lancet. 304(7879):477-81.

Hirschel BJ, Benusiglio LN, Favre H, Chalelanat F, Humair L, Zubler RH, et al. Glomerulonephritis associated with hepatitis B, report of a case and review of literature. Clin Nephrol. 1977;8(3):404-9.

Knetchel GL, Chisari FV. Reversibility of hepatitis B virus – induced glomerulonephritis and chronic active hepatitis after spontaneous clearance of serum hepatitis B surface antigen. Gastroenterology. 1978;75(6):1152-6.

Baxter JH, Ashworth CT. Renal lesions in portal cirrhosis. Arch Pathol(Chic.). 1946;41:476-88.

Wilkinson SP, Hirst D, Day DW, Williams R. Spectrum of renal tubular damage in renal failure secondary to cirrhosis and fulminant hepatic failure. J Clin Pathol. 1978;31(2):101-7.

Baldus WP, Feichter RN, Summerskill WH. The kidney in cirrhosis. I. Clinical and Biochemical features of azotemia in hepatic failure. Ann Intern Med. 1964;60:353-65.

Shear L, Kleinerman J, Gabuzda GJ. Renal failure in patients with cirrhosis of the liver. I. Clinical and pathologic characteristics. Am J Med. 1965;39:184-98.

Nagy J, Bajtai G, Brasch H, Sule T, Ambrus M, Deak G, et al. The role of hepatitis B surface antigen in the pathogenesis of glomerulopathies. Clin. Nephrol. 1979;12(3):109-16.

Pouria G, Feehally J. Glomerular IgA deposition in liver disease. Nephrol Dial Transplant. 1999;14:2279-82.

Silvain C, Patry C, Launay P, Lehuen A, Monteiro RC. Altered expression of monocyte immunoglobulin A Fc Receptor is associated with defective endocytosis in patients with alcoholic cirrhosis: Potential role for IFN- γ. J Immunol. 1995;155:1606-18.