Background: Decompensated Chronic liver disease and cirrhosis are frequently complicated with renal dysfunction and this combination, called Hepato-Renal Syndrome (HRS) leads to significant morbidity and mortality. Acute renal dysfunction occurs in 15% to 25% of hospitalized patients with cirrhosis. The annual frequency of Hepato-renal syndrome(HRS) in cirrhotic patients with ascites is roughly 8% and, in some reports, as high as 40%.The observation that morbidity and mortality remain high once the syndrome is established has led to a focus on the prevention and early therapy of renal dysfunction in patients with cirrhosis. Hepato-renal syndrome (HRS) is a serious complication of liver cirrhosis with critically poor prognosis. Rapid diagnosis and management are important, since recent treatment modalities including vasoconstrictor therapy can improve short-term outcome and buy time for liver transplantation, which can result in complete recovery. Recognizing the trait about chronic alcoholism in a patient, counselling by doctor about avoidance of alcohol, & early recognition of progression to CLD by investigations may be helpful in preventing this complication. Aims and Objectives: To study clinical profile, assess the course and severity and outcome of patients admitted with alcohol induced chronic liver disease with hepato-renal syndrome. Methodology: A prospective (observational), hospital based study was carried out in 57 patients who met our inclusion criteria. Results: The study population's most common age group was between 36 and 45 years (33.3%), 46 to 55 years (24.6%), and more than 55 years (22.8%) with the mean age of 43 + 7.8 years amongst study population with a male predominanace (87.7%), Icterus and ascitis (100%) followed by Flapping tremors (98.25%), Oliguria (82.5%), Edema Feet (73.68%), Altered sensorium (66.7%) and Abdominal Distension (59.65%) were the commonest clinical features. History of alcohol intake for more than 10 years (61.4%) followed by less than 10 years (38.6%) and most of them were heavy drinkers (>4 drinks per day) (44.2%) while moderate and light drinkers (2-4 drinks/day and 1-2 drinks/day ) were 32.7% and 23.1% respectively. Previous history of admissions due to similar or related illness was observed in 78.9% of study population. Most of our patients had Type I HRS (75.4%) followed by Type II (24.53%). In our study, death was occurred in all patients with worsened hepatic and renal dysfunction (100%) and the difference was statistically significant. Conclusion: Hepato Renal Syndrome is a major decompensation in advanced alcohol induced liver cirrhosis with a high short-term mortality rate.
- Lata J. Hepatorenal syndrome. World Journal of Gastroenterology: WJG. 2012 Sep 28; 18(36):4978. https://doi.org/10.3748/wjg.v18.i36.4978. PMid:23049205 PMCid:PMC3460323 DOI: https://doi.org/10.3748/wjg.v18.i36.4978
- Wong F, Nadim MK, Kellum JA, et al. Working party proposal for a revised classification system of renal dysfunction in patients with cirrhosis. Gut. 2011; 60(5):702-709. https://doi.org/10.1136/gut.2010.236133. PMid:21325171 DOI: https://doi.org/10.1136/gut.2010.236133
- Moreau R, Lebrec D. Acute renal failure in patients with cirrhosis: Perspectives in the age of MELD. Hepatology. 2003 Feb 1; 37(2):233-43. https://doi.org/10.1053/jhep.2003.50084. PMid:12540770 DOI: https://doi.org/10.1053/jhep.2003.50084
- Prakash J, Mahapatra AK, Ghosh B, Arora P, Jain AK. Clinical spectrum of renal disorders in patients with cirrhosis of liver. Renal failure. 2011 Feb 1; 33(1):40-6. https://doi.org/10.3109/0886022X.2010.541582. PMid:21219204 DOI: https://doi.org/10.3109/0886022X.2010.541582
- Sherman DS, Fish DN, TeitelbaumI. Assessing renal function in cirrhotic patients: problems and pitfalls. Am J Kidney Dis. 2003; 41(2):269 -78. https://doi.org/10.1053/ajkd.2003.50035. PMid:12552488 DOI: https://doi.org/10.1053/ajkd.2003.50035
- Arroyo V, Guevara M, Ginès P. Hepatorenal syndrome in cirrhosis: Pathogenesis and treatment. Gastroenterology. 2002 May 1; 122(6):1658-76. https://doi.org/10.1053/gast.2002.33575. PMid:12016430 DOI: https://doi.org/10.1053/gast.2002.33575
- Gines A, Escorsell A, Gines P, et al. Incidence, predictive factors and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gastroenterology. 1993; 105(1):229-36. https://doi.org/10.1016/0016-5085(93)90031-7 DOI: https://doi.org/10.1016/0016-5085(93)90031-7
- Martín-Llahi M, Guevara M, Torre A, Fagundes C, Restuccia T, Gilabert R, Sola E, Pereira G, Marinelli M, Pavesi M, Fernández J. Prognostic importance of the cause of renal failure in patients with cirrhosis. Gastroenterology. 2011 Feb 1; 140(2):488-96. https://doi.org/10.1053/j.gastro. 2010.07.043. PMid:20682324
- Wong F, Leung W, Al Beshir M, Marquez M, Renner EL. Outcomes of patients with cirrhosis and hepatorenal syndrome type 1 treated with liver transplantation. Liver Transplantation. 2015 Mar; 21(3):300-7. https://doi.org/10.1002/lt.24049. PMid:25422261 DOI: https://doi.org/10.1002/lt.24049
- Jiang Y, Zhang T, Kusumanchi P, Han S, Yang Z, Liangpunsakul S. Alcohol metabolizing enzymes, microsomal ethanol oxidizing system, cytochrome P450 2E1, catalase, and aldehyde dehydrogenase in alcohol-associated liver disease. Biomedicines. 2020 Mar; 8(3):50. https://doi.org/10.3390/biomedicines8030050. PMid:32143280 PMCid:PMC7148483 DOI: https://doi.org/10.3390/biomedicines8030050
- Zhou Z, Wang L, Song Z, Lambert JC, McClain CJ, Kang YJ. A critical involvement of oxidative stress in acute alcoholinduced hepatic TNF-α production. The American Journal of Pathology. 2003 Sep 1; 163(3):1137-46. https://doi.org/10.1016/S0002-9440(10)63473-6 DOI: https://doi.org/10.1016/S0002-9440(10)63473-6
- Lee JP, Heo NJ, Joo KW, Yi NJ, Suh KS, Moon KC, Kim SG, Kim YS. Risk factors for consequent kidney impairment and differential impact of liver transplantation on renal function. Nephrology Dialysis Transplantation. 2010 Aug 1; 25(8):2772-85. https://doi.org/10.1093/ndt/gfq093. PMid:20207711 DOI: https://doi.org/10.1093/ndt/gfq093
- Pathak OK, Paudel R, Panta OB, Pant HP, Giri BR, Adhikari B. Retrospective study of the clinical profile and prognostic indicators in patients of alcoholic liver disease admitted to a tertiary care teaching hospital in Western Nepal. Saudi Journal of Gastroenterology: Official Journal of the Saudi Gastroenterology Association. 2009 Jul; 15(3):171. https://doi.org/10.4103/1319-3767.54746. PMid:19636178 PMCid: PMC2841416 DOI: https://doi.org/10.4103/1319-3767.54746
- Salerno F, Cazzaniga M, Merli M, Spinzi G, Saibeni S, Salmi A, Fagiuoli S, Spadaccini A, Trotta E, Laffi G, Koch M. Diagnosis, treatment and survival of patients with hepatorenal syndrome: A survey on daily medical practice. Journal of Hepatology. 2011 Dec 1; 55(6):1241-8.
- Watt K, Uhanova J, Minuk GY. Hepatorenal syndrome: diagnostic accuracy, clinical features, and outcome in a tertiary care center. The American Journal of Gastroenterology. 2002 Aug 1; 97(8):2046-50. https://doi.org/10.1111/j.1572-0241.2002.05920.x. PMid:12190175 DOI: https://doi.org/10.1111/j.1572-0241.2002.05920.x
- Sarin SK, Kumar A, Almeida JA, Chawla YK, Fan ST, Garg H, de Silva HJ, Hamid SS, Jalan R, Komolmit P, Lau GK. Acute-on-chronic liver failure: Consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL). Hepatology international.
- Mumenthaler MS, Taylor JL, O'Hara R, Yesavage JA. Gender differences in moderate drinking effects. Alcohol Research and Health. 1999; 23(1):55. https://doi.org/10.1111/j.1530-0277.1999.tb04107.x DOI: https://doi.org/10.1111/j.1530-0277.1999.tb04107.x