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Can we predict early renal impairment in pediatric cirrhosis?

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Abstract

Aims

Published literature on renal dysfunction (RD) in pediatric cirrhosis are limited. We aimed to detect early RD in cirrhotic children by renal resistive index (RI) and plasma aldosterone (PA). We evaluated the effects of large-volume paracentesis (LVP) and albumin infusion on the same.

Methods

Non-azotemic cirrhotic children with tense ascites (undergoing LVP with albumin infusion) were prospectively enrolled. Blood biochemistry and doppler ultrasonography for RI and PA were measured at regular intervals. RI >0.7 was considered as RD. Outcomes were noted at D90 and 1 year. Chronic liver disease children without ascites were included as controls.

Results

Of the 99 cirrhotic children, tense ascites (n=51) had higher baseline RI than controls (n=48) (p<0.001). Overall, baseline RD was observed in 32% and was significantly higher in tense ascites compared to controls (59% vs. 4%, p<0.001). Tense ascites with RD at admission had higher chances of acute kidney injury (AKI) (p=0.009), ascites recurrence (p=0.043), hospital readmission (p=0.048), and mortality (p=0.009) compared to patients without RD by D90. Significant reduction in RI was noted at 48 h, D7, D30, and D90 compared to baseline after LVP with albumin. Pediatric End-stage Liver Disease (PELD) score and PA had a strong positive correlation with baseline RI (R2=0.51, R2=0.47). Using multivariate analysis, PELD score and PA were predictors of AKI (odds ratio [OR]: 1.14; 95% confidence interval [CI]: 1.04–1.24; p=0.003) and mortality (OR: 1.82; 95% CI: 1.22–2.72; p=0.004), respectively.

Conclusions

Abnormal baseline RI can be used as an early predictor of RD and predict long-term renal ouctomes in pediatric cirrhosis. Baseline RI correlated well with the severity of liver disease and PA. Paracentesis and albumin infusion effectively reduced RI.

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Acknowledgements

We would like to thank senior laboratory technicians Ms. Amrita Mathias and Mr J. Raj for their valuable help in sample collection, processing, and estimation of plasma aldosterone.

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Authors and Affiliations

  1. Departments of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India

    Durga Prasad, Moinak Sen Sarma, Surender Kumar Yachha, Anshu Srivastava & Ujjal Poddar

  2. Departments of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India

    Raghunandan Prasad

  3. Departments of Biostatistics and Heath Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India

    Anup Kumar

Authors
  1. Durga Prasad
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  2. Moinak Sen Sarma
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  3. Surender Kumar Yachha
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  4. Raghunandan Prasad
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  5. Anshu Srivastava
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Contributions

Durga Prasad: collection of data, study design, data analysis and primary drafting of manuscript. Moinak Sen Sarma: study design, data analysis, intellectual inputs, final drafting of manuscript. Surender Kumar Yachha: study design, intellectual inputs, supervision of study. Raghunandan Prasad: performed renal Doppler ultrasonography. Anshu Srivastava and Ujjal Poddar: intellectual inputs, study supervision. Anup Kumar: statistical analysis

Corresponding author

Correspondence to Surender Kumar Yachha.

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Conflict of interest

DP, MSS, SKY, RP, AS, UP, and AK declare no competing interests.

Ethics statement

The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

Ethics

The institutional ethics committee approved this study (IEC code: 2016-121-DM-92 dated 16.09.2016). Informed consent was taken in each patient.

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The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, the Indian Society of Gastroenterology or the printer/publishers are responsible for the results/findings and content of this article.

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Prasad, D., Sen Sarma, M., Yachha, S.K. et al. Can we predict early renal impairment in pediatric cirrhosis?. Indian J Gastroenterol 41, 135–142 (2022). https://doi.org/10.1007/s12664-021-01190-8

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  • DOI: https://doi.org/10.1007/s12664-021-01190-8

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