Rosenkranz Background While functional renal dysfunction is assessed by using Acute Kidney Injury Network (AKIN) criteria, the true spectrum of kidney injury remains speculative. Since majority of patients are very sick and coagulopathic,
there selleck screening library is paucity of data on renal biopsies and structural renal pathologies in patients with cirrhosis and acute on chronic liver failure (ACLF). Patients and Methods: We reviewed the post-mortem kidney biopsy reports of patients with severe liver dysfunction who died with acute kidney injury (AKI). Biopsy tissues were processed and subjected to light microscopy and immunofluorescence. In patients with pigment casts in tubules, additional special stains for iron (Pearl’s stain) and bile (Fouchet’s) were used to characterise the pigments. Results: Total of 43 renal biopsies of patients with complete clinical details and death with AKI were included;
18 patients had ACLF and 25 were decompensated cirrhotics. Mean age of study population was 43.26±11.44 years. All 43 (100%) patients had renal structural anomalies. Bile pigment nephropathy was found in 20/43 (46.51%) and acute tubular necrosis (ATN) in 23/43 (53.49%) patients. ACLF patients had significantly more number of bile pigment nephropathy as compared to cirrhotics (72%vs 27.8%, p value = 0.004). learn more The mean urea (98.80±55.78 vs 90±44.68 mg/ dl, p value = 0.294) and creatinine (4.02±2.3 vs 3.42±1.5 mg/dl, p value = 0.081) were higher in bile pigment nephrop-athy group compared to ATN group. The Mean CTP score was higher in bile pigment nephropathy group compared to ATN group (12.6±1.1 vs. 11.9±1.2, p value = 0.046). The Mean MELD score (39.3±7.9 and 31.35±7.7) and bilirubin (26.06±9.3 and 9.2±5.2
mg/dl) were higher in bile pigment nephropathy group as compared to ATN group (p value = 0.002 and <0.001 respectively). On multivariate logistic MCE regression analysis, high bilirubin was found to be an independent predictor of bile pigment nephropathy. Conclusion: Patients with decompensated cirrhosis and ACLF, who develop severe AKI, do have renal structural anomalies. Bile pigment nephropathy is a common pathological finding; more so in ACLF patients with high serum bilirubin. ATN should be suspected early enough in decompensated cirrhotics. Disclosures: The following people have nothing to disclose: Suman Nayak, Rajendra P. Mathur, Sivaramakrishnan Ramanarayanan, Gyan Prakash, Shiv K. Sarin, Chi-transhu Vashishtha, Manoj Kumar, Rakhi Maiwall, Ajeet S. Bhadoria Background & Aims: Plasma renin concentration (PRC) has been reported to be elevated in patients with liver cirrhosis. It remains to be established if PRC is associated with portal hypertension (PHT), degree of liver dysfunction, and mortality in cirrhosis.