Effect of renal dysfunction in fulminant hepatic failure.

ABSTRACT

BACKGROUND: Effect of renal dysfunction in fulminant hepatic failure is not studied extensively. METHODS: Fifty consecutive patients of fulminant hepatic failure were studied prospectively to determine the prevalence of renal failure and its effect on survival. RESULTS: The mean age of these patients was 36 +/- 7.2 years and there were 21 males and 29 females. Twenty two patients (44%) were hepatitis B surface antigen (HBsAg) positive. Renal dysfunction was observed in 19 patients (38%). Acute tubular necrosis was seen in 7 patients (38%) while prerenal azotemia and functional renal failure occurred in six patients each (37%). Renal failure occurred more commonly in patients with jaundice. In these patients it occurred in less than four days and prior to onset of encephalopathy, ascites, and gastrointestinal hemorrhage. Histopathological examination of kidney (done in 8 patients) revealed acute tubular necrosis in 4 patients while patients with functional renal failure and prerenal azotemia had normal histology. A good correlation was observed between biochemical parameters and histology of kidney in all the patients. The survival amongst the patients with FHF was 28% (14 of 50 patients). Poor prognostic indicators were a leukocyte count of more than 16.5 x 10(9)/liter, prothrombin index of less than 34%, a peak serum bilirubin of more than 376 mumol/liter and presence of renal failure. Only 3 of 19 patients with renal failure survived. CONCLUSIONS: Renal dysfunction is a major indicator of poor prognosis in patients with FHF.