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Experiences with acute kidney injury complicating non‐fulminant hepatitis A
Author(s) -
KIM HYUN W,
YU MI H,
LEE JANG H,
CHANG JAI W,
YANG WON S,
KIM SOON B,
LEE SANG K,
PARK JUNG S,
PARK SUKIL
Publication year - 2008
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/j.1440-1797.2008.00974.x
Subject(s) - medicine , acute kidney injury , creatinine , acute tubular necrosis , gastroenterology , renal function , fulminant hepatitis , bilirubin , coagulopathy , hepatitis , jaundice , surgery
SUMMARY: Aim: To describe the clinical features and to identify factors related to development of acute kidney injury in acute hepatitis A patients. Methods: The study and control groups consisted of 21 and 425 patients who did or did not develop acute kidney injury, respectively, after acute hepatitis A from January 1997 to May 2007. Results: There were 13 men and eight women; their mean age at diagnosis was 28.8 ± 8.2 years in the study group. Peak values for renal and liver function impairment consisted of a median serum creatinine of 4.6 mg/dL (range, 1.5–15.3 mg/dL) on day 6 (range, days 1–20) and a median total bilirubin of 10.7 mg/dL (range, 2.6–57.5 mg/dL) on day 8 (range, day 1–19). Serum creatinine concentrations returned to baseline level by a median of 16 days and total bilirubin levels returned to normal by a median of 62 days. Six of 21 (29%) patient underwent haemodialysis. Renal biopsies performed in two patients showed acute tubular necrosis and interstitial nephritis, respectively. Logistic regression analysis showed that a lower haematocrit, the presence of coagulopathy and high C‐reactive protein concentration on admission, and higher peak bilirubin value during the illness were associated with development of acute kidney injury. Conclusion: Acute hepatitis A should be considered in the differential diagnosis of patients with acute kidney injury, even without fulminant hepatic failure. A lower haematocrit, the presence of coagulopathy and high C‐reactive protein level at presentation, and higher peak bilirubin level during the illness were associated with development of acute kidney injury in acute hepatitis A patients.