간경변 환자에서 급성신부전의 위험인자

Abstract

Background : Renal dysfunction occurs in up to 75% of patients with liver cirrhosis and is a major cause for mortality and morbidity. Hyperbilirubine mia, hepatic encephalopathy, spontaneous bacterial peritonitis and underlying renal insufficiency have been reported as risk factors for renal dysfunction in patients with liver cirrhosis, but further evaluations are still being required. Methods : We retrospectively analized 91 liver cirrhosis patients hospitalized at Severance Hospital between Jan 1, 1996 and Dec 31, 2001 who had normal renal function at admission. Results : Forty-four patients were enrolled in renal dysfunction group and forty-seven patients in control group. There were no significant differences between two groups in age, cause for liver cirrhosis, presence of diabetes mellitus, history of aminoglycoside treatment, serum albumin level, and prothrombin time. The incidence of ascites (95% vs. 47%), hepatic encephalopathy (66% vs. 17%), bacteremia (38% vs. 4%), urinary tract infection (16% vs. 2%), spontaneous bacterial peritonitis (30% vs. 6%). and upper gastrointestinal bleeding (25% vs. 9%) were significantly high in renal dysfunction group, compared to control group (p<0.05). In renal dysfunction group, the level of total bilirubin (9.1±8.3 mg/dL vs. 3.5±6.2 mg/dL) was also much higher than control group. Multiple logistic regression analysis showed ascites, hepatic encephalopathy, and bacteremia as independent risk factors for renal dysfunction. Conclusion : Ascites, hepatic encephalopathy, and bacteremia are postulated to be risk factors for renal dysfunction in liver cirrhosis patients. Renal function and urine output should be cautiously monitored in liver cirrhosis patients with these risk factors.