Bilirubin is related to severity of acute kidney injury in patients with viral hepatitis A

초록

Background: Flu-like outbreaks of viral hepatitis A(VHA) were occured in South Korea for recent years. The existence of VHA-related renal failure as a distinct disease entity is controversial. The purpose of this study was to analyze the clinical features of acute renal injury(AKI) in adults with hepatitis A. Methods:Clinical and laboratory data of patients with AHA from January 2005 to December 2009 were analysed in our hospital. The diagnosis of AKI was based on appropriate laboratory investigations and RIFLE criteria. Results: Total 1231 patients with VHA were admitted during 5 years and the incidence of AHA was explosively increased since 2008. AKI was noted in 40 cases in those hepatitis A patients(3.24 %). Mean ages of AKI patients were in the middle of 4th decade, male was 33 (82.5%). In AKI group serum creatinine levels were peak (6.3 ± 5.7 mg/dl) at 3rd hospital day. Serum AST, ALT and total bilirubin were 2353 ± 2547 IU/l, 2887 ± 2052 IU/I, and 9.3 ± 5.4 mg/dl respectively at that time. The serum creatinine(11.4 ± 5.5 vs 3.1 ± 1.8 and total bilirubin(8.7± 4.6 vs 4.5 ± 2.1mg/dl) were significantly higher in patients of AKI group than non-AKI group. Oliguria was seen in 85 % of AKI group with three biopsy showing interstitial nephritis. Mean 4.3 ± 2.3 sessions of HD were performed in oliguric AKI with high level of bilirubin and renal function was completely recovered early than liver function. Conclusion:AKI is not rare complication of VHA. The renal function and morbidity were determined by the liver dysfunction in hepatitis A, and level of total bilirubin seems to be related to severity of AKI.