assessment of renal changes in patients with non alcoholic fatty liver disease

Conditions: Non-Alcoholic Fatty Liver Disease; Chronic Kidney Diseases

Summary: assess the renal changes in patients with non-alcoholic fatty liver (nafld).

* non-alcoholic fatty liver disease (nafld) is the accumulation of fat (\>5%) in liver cells in the absence of excessive alcohol intake or other causes of liver disease. the histologic spectrum of nafld ranges from simple steatosis to non-alcoholic steatohepatitis (nash), liver fibrosis, and cirrhosis. this disease affects up to 30% of the general population in western countries, especially in patients with metabolic syndrome, obesity, and type ii diabetes. * accumulating epidemiologic evidence indicates that nafld not only affects the liver but also increases the risk of extra-hepatic diseases such as type 2 diabetes mellitus, metabolic syndrome, hypertension, cardiovascular or cerebrovascular diseases, and chronic kidney disease. * chronic kidney disease (ckd) is defined by decreased estimated glomerular filtration rate (egfr) and/or the presence of significant proteinuria. its prevalence is \~ 4.3 - 13% in general population, but it is expected to increase and \~ 50% of these patients develop end-stage renal disease. recently, ckd is significantly higher in patients with nafld than patients without. * several studies have demonstrated that nafld independently contributes to increasing the risk of ckd where nafld and ckd may share many common cardio-metabolic risk factors e.g. insulin resistance, chronic inflammation, and obesity. * the exact pathophysiologic mechanisms linking nafld to ckd are not completely understood, however, there is increased production of various proinflammatory cytokines, reactive oxygen species, tnf-α, c-reactive protein (crp), and il-6 by hepatocytes and non-parenchymal cells (kupffer cells and hepatic stellate cells) that can link nafld and ckd. in addition, altered rennin-angiotensin system activation can be involved. * several western studies had evaluated the relationship between nafld and ckd and shown the prevalence of ckd in nafld patients between 4 - 40%. * an analysis of the united network organ sharing (unos) data base during the years (2002-2011) revealed that 35% of the patients transplanted for nafld-related cirrhosis progressed to stage 3-4 ckd within 2 years after liver transplantation in comparison to 10% of patients transplanted for other etiologies. * despite these findings ckds often goes unrecognized and the third national health and nutrition survey (nhanesiii), among all individuals with moderately decreased gfr (less than 60ml/min; stage 3) reported the awareness was approximately 8%. * there is still very little prospective studies and data linking nafld to ckd, and it is lacking in the middle east region.

Eligibility criteria:
inclusion criteria: •patients diagnosed as nafld by abdominal ultrasonography, fibroscan, nafld fibrosis score and fib-4 score exclusion criteria: * patients with diabetes and/or hypertension. * patients with chronic renal disease. * patients with urinary tract infections. * patients on medications affecting the kidney (eg: nsaids,..etc) * patients with chronic liver disease other than nafld (chronic hepatitis; viral b,c, autoimmune etc). * alcohol consumption.