Frequency of hepatorenal syndrome among cirrhotics.

Objective: To determine the frequency of hepatorenal syndrome in patients with chronic liver disease and ascites.

Design: A cross-sectional study.

Place And Duration Of Study: From July 2001 to March 2002 at Civil Hospital, Karachi.

Patients And Methods: The study included 240 patients who were admitted in the Medical Wards of Civil Hospital, Karachi, during the study period. The subjects were diagnosed as having chronic liver disease and all of them had ascites. All the patients with renal dysfunction were identified and were worked up for hepatorenal syndrome and other causes of renal dysfunction.

Results: Of two hundred and forty (240) patients enrolled in the study, 148 were male (61.7%) and 92 were female (38.3%). Seventy-six (76) patients (31.6%) were found to have renal impairment as diagnosed by serum creatinine level of 1.5 mEq/L or greater. Six (6) patients showed improvement in their serum creatinine level (below 1.5 mg/dL) after receiving 1.5 liter of normal saline infusion and diuretic withdrawal. Eleven (11) patients were diagnosed to have primary renal disease based on urine analysis, urinary protein excretion and ultrasound examination. Six (6) patients were diagnosed to have renal dysfunction secondary to analgesic nephropathy and in seventeen (17) patients renal dysfunction was secondary to spontaneous bacterial peritonitis. The remaining 36 (47.4%) patients with renal dysfunction were diagnosed as suffering from hepatorenal syndrome based on the diagnostic criteria. This represents the frequency of 15% among patients with chronic liver disease and ascites.

Conclusion: Hepatorenal syndrome is common complication in patients with cirrhosis and ascites. It was the most common cause of renal impairment in this series followed by other causes like spontaneous bacterial peritonitis, primary renal disease, analgesic nephropathy and hypovolemia.