#503 The influence of the degree of liver cell failure on the functional state of the kidneys in patients with liver cirrhosis
Authors: Daminov Botir , Usmonov Dilshod , Abdurazakova Zarifa , Yuldashova Yulduz 
Published: May 2024

Abstract

Background and Aims
Studying the influence of the severity of liver cirrhosis on the functional ability of the kidneys in patients without concomitant diseases (without diabetes mellitus and hypertension).

Method
The study included 38 patients with liver cirrhosis who were treated in the gastroenterology department of the Republican Scientific and Practical Center for Therapy and Medical Rehabilitation in Tashkent.
The average age of patients was 54 ± 3.4 (from 33 to 65).
The examined patients were divided into two groups, depending on the degree of hepatic cellular failure (according to the Child-Pugh classification) and the development of ascitic syndrome. In group 1 Liver cirrhosis without ascites (P-P class A) the number of patients was 20. In group 2 Liver cirrhosis with ascites (P-P class B) the number of patients was 18. When examining patients, we used: Clinical blood test; blood chemistry; determination of electrolytes, creatinine; general urine analysis; glomerular filtration level; Functional renal reserve (defined as the increase in glomerular filtration expressed as a percentage after the administration of Dopamine at a dose of 2-3 μg/kg/min. To assess portal hypertension, all patients underwent ultrasound examination of the organs abdominal cavity and duplex scanning of portal system vessels.

Results
The examined patients were analyzed for the functional state of the kidneys and its relationship with the main parameters of portal hypertension and hepatic cell failure. Comparative characteristics of the main indicators of renal function significant differences in functional parameters were revealed depending on degree of hepatic cell failure.
In the group of patients with cirrhosis with ascites, there was a significant decrease in renal GFR to 77.5 ± 1.4 ml/min, in contrast to the unchanged level of GFR in the group of patients with cirrhosis without ascites—99.3 ml/min.
In patients with cirrhosis without ascites, the glomerular filtration rate increases by against the background of dopamine administration was 13.5 ± 4.7% (which corresponds to the norm), in contrast to patients in the second group, where the average Renal Functional Reserve was 8.4 ± 2.8%.
Changes in renal function were also characterized by a decrease in Fractional Excretion of Sodium (FENa). The reduction in FENa in the group of patients with persistent ascites.
During a detailed assessment of the RFR in patients of the first group, the RFR was below normal only in 2.6 ± 2.5%, while in the second group the number of patients with the decrease in the RFR was 69.7 ± 8.1%. Study of functional renal reserve in a group of patients with cirrhosis with ascites revealed unchanged this indicator in only 10 (30.3 ± 8%). U 19 (57.5 ± 8.6%) of patients in this group, the RFR was less than 10%, and in 12.2 ± 5.7% cases of RFR was below 5%, which indicated pronounced intraglomerular hypertension and the risk of developing resistant ascites.

Conclusion
The present study indicates that Renal Functional Reserve (RFR) in patients with liver cirrhosis reflects the speed of effective renal plasma flow. A decrease in FPR in Child-Pugh class A liver cirrhosis was detected in 2.6% of cases, with hepatic cell failure, Child-Pugh class B in 69.7%.