Studies on renal function in Schistosomal hepatic fibrosis with and without ascites

ABSTRACT

This study was carried out on 50 male patients with schistosomal bepatic fibrosis, 30 with resistant ascites, 10 with reversible ascites and 10 non-ascitic patients. The schistosomal nature of the disease was ascertained by proper history, clinical picture, stool and urine analysis and rectal mucosal scraping with sigmoidoscopic examination. Thirty-two patients had schistosoma mansoni while the remaining eighteen had combined schistosoma mansoni and haematobium infestation. All the studied patients were subjected to full history taking, thorough clinical examination, routine laboratory tests and renal function studies. Marked degree of water retention was apparent in patients with resistant ascites. Dilution study revealed diminished water elimination in cases without or with reversible ascites. Renal tubular concentration studies appeared to be normal in patients without or with reversible ascites. On the other hand schistosomal patients with resistant ascites showed variable degrees of impaired renal tubular concentrating capacity. The data of sodium clearance studies indicated that all patients with schistosomal hepatic fibrosis retained sodium avidly, especially those with resistant ascites. The glomerular filtration rate as assessed by endogenous creatinine clearance was markedly reduced in schistosomal patients with resistant ascites. The glomerular filtration rate was normal in non-ascitic patients and moderately reduced in patients with reversible ascites. Renal plasma and renal blood flow were markedly reduced in patients with resistant ascites, while mild decrease was observed in patients with reversible ascites and normal levels were obtained it non-ascitic patients