Functional and ultrasonographic renal assessment in children with liver cirrhosis

ABSTRACT

Twenty Child's grade "A" cirrhotic children [9 cryptogenic, 6 posthepatitic, 2 biliary, 2 following AI CAH and one metabolic] whose ages ranged between 3 and 15 years [mean 7.1 + or ' 3.4 years] were studied clinically, biochemically and ultrasonographically for assessment of their renal performance. Seven normal children served as a control group. Serum creatinine, creatinine clearance and blood urea showed no statistically significant differences between patients and controls [P >0.05 for each]. On the other hand, the mean FENa% in patients [0.49 +/- 0.24%] was statistically significantly lower than that of controls [0.70 +/- 0.23%] [P <0.05] while their FEPO4% [16.77 +/- 7.9%] was statistically significantly higher than that of controls [9.29 +/- 6.5%] [P <0.05]. The patients' mean serum phosphorus [4.24 +/- 0.63 mg/dl] was lower than that of controls [4.86 +/- 0.83 mg/dl] [P <0.05]. Microalbuminuria, an indicator of increased glomerular permeability, was statistically significantly higher in patients [9.75 +/- 23.9 mg/dl] than controls [0.55 +/- 0.08 mg/dl] [P <0.05]. Urinary alpha 1 microglobulin, an indicator of tubular proteinuria, was also higher in patients [12.55 +/- 14.6 mg/g cr] compared to controls [1.98 +/- 4 mg/g cr] [P <0.01]. Microabluminuria correlated significantly and positively with serum creatinine [r = 0.55] and alpha 1 MG [r = 0.54] while it correlated negatively with creatinine clearance [r = 0.45] and serum albumin [r = -0.4]. Alpha 1 MG correlated significantly and positively with serum creatinine [r = 0.72], ALT [r = 0.53] and AST [r = 0.52] while it showed a significant negative correlation with serum albumin [r = -0.44]. Ultrasonographic measurements of right kidney size, left kidney size and renal parenchymal thickness in patients showed no statistically significant difference from those of controls [P >0.05 for each]. Also, all patients except two showed a normal echogenicity. Thus, although the patients with compensated cirrhosis had no clinical or laboratory evidence of renal impairment yet they had microalbuminuria and increased excretion of alpha 1 MG both of which are early predictors of glomerular and tubular dysfunction, respectively