Acute renal failure associated with liver disease in India: Etiology and outcome

Background/Aims and Method Acute renal failure (ARF) associated with liver disease is a commonly encountered clinical problem of varied etiology and h igh mortality. We have prospectively analyzed patients with liver disease a nd ARF to determine the etiology, clinical spectrum, prognosis and factors affecting the outcome. Results Other than hepatorenal syndrome patients, out of 221 cases, 66 deve loped ARF secondary to various liver disease like cirrhosis (n = 29, mortal ity 8, risk factors-older age p < 0.01, grade III/IV encephalopathy p < 0.0 5), fulminant hepatic failure (n = 25, mortality 15, risk factor-prolonged prothrombin time p < 0.01), and obstructive jaundice (n = 12, mortality 7, risk factor-sepsis p < 0.01). In these three groups the factors leading to ARF were volume depletion (24), gastrointestinal bleed (28), sepsis (34), d rugs (27) [aminoglycosides (9) and NSAID (18)] along with hyperbilirubinemi a. Various types of ARF with contemporaneous liver injury were malaria (n = 37, mortality 15, risk factors-higher bilirubin p < 0.001, higher creatini ne p < 0.05, anuria p < 0.05 and dialysis dependency p < 0.05), sepsis (n = 36, mortality 22, risk factors-age p < 0.001, higher bilirubin p < 0.01, o liguria p < 0.05), hypovolemia with ischemic hepatic injury (n = 14, mortal ity 5, risk factors-higher creatinine p<0.05 and SGPT p < 0.01), acute panc reatitis (n = 12, mortality 4, risk factors-higher bilirubin p<0.001, highe r SGPT p<0.01, dialysis dependency p < 0.05), rifampicin toxicity (n = 10, no mortality), paroxysmal nocturnal hemoglobinuria (n = 3, no mortality), C uSO4 poisoning (n = 3 mortality 2), post abortal (n = 11, mortality 6, risk factors-higher creatinine p < 0.05 and SGPT p < 0.01), ARF following deliv ery including HELLP syndrome (n = 12, mortality 4, risk factors-higher bili rubin p < 0.01 and SGPT p < 0.01), and of uncertain etiology (n=14 mortalit y 4). 133 patients (60.2%), required hemodialysis hemodialfiltration or per itoneal dialysis. Conclusion ARF associated with Liver disease is having high mortality (42.5 %). Avoidance of dehydration, hypotension, nephrotoxic drugs and sepsis, wi th promot dialytic support are necessary to reduce mortality and morbidity.