🦠 CASE 1: HEPATORENAL SYNDROME (HRS) IN CIRRHOSIS
📌 Clinical Scenario:
A 58-year-old male with decompensated cirrhosis (due to hepatitis C) presents with ascites, jaundice, confusion, oliguria, and hypotension.
📊 KFT & LFT REPORTS:
| Test | Value | Normal Range | Interpretation |
|---|
| Bilirubin (Total) | 9.2 mg/dL | 0.1 – 1.2 mg/dL | Severe jaundice |
| ALT (SGPT) | 65 U/L | 7 – 56 U/L | Liver dysfunction |
| AST (SGOT) | 90 U/L | 10 – 40 U/L | Alcoholic liver damage |
| INR (Coagulation) | 2.2 | <1.1 | Liver failure, coagulopathy |
| Ammonia (Plasma) | 180 µmol/L | 15 – 45 µmol/L | Hepatic encephalopathy |
| Creatinine | 3.5 mg/dL | 0.6 – 1.2 mg/dL | Hepatorenal Syndrome (Type 1) |
| BUN | 65 mg/dL | 7 – 20 mg/dL | Acute kidney injury |
| Urine Sodium | <10 mEq/L | 20 – 40 mEq/L | Pre-renal failure |
📝 Diagnosis:
- Hepatorenal Syndrome (Type 1) due to End-Stage Liver Disease
✅ Management:
- IV Albumin + Vasopressors (Terlipressin)
- Paracentesis with Albumin Infusion for ascites
- Consider Liver Transplant (Definitive Treatment)
🦠 CASE 2 : CHOLESTATIC LIVER DISEASE WITH NEPHROTIC SYNDROME
📌 Clinical Scenario:
A 47-year-old female with primary biliary cholangitis (PBC) presents with pruritus, jaundice, and lower limb edema.
📊 KFT & LFT REPORTS:
| Test | Value | Normal Range | Interpretation |
|---|
| Bilirubin (Total) | 5.0 mg/dL | 0.1 – 1.2 mg/dL | Obstructive jaundice |
| Alkaline Phosphatase (ALP) | 420 U/L | 44 – 147 U/L | Cholestatic disease |
| GGT (Gamma-GT) | 310 U/L | 9 – 48 U/L | Biliary dysfunction |
| Creatinine | 2.5 mg/dL | 0.6 – 1.2 mg/dL | Nephrotic syndrome due to PBC |
| Urine Protein/Creatinine Ratio | 4.6 g/g | <0.2 g/g | Severe proteinuria |
| Albumin (Serum) | 2.0 g/dL | 3.4 – 5.4 g/dL | Hypoalbuminemia |
📝 Diagnosis:
- Primary Biliary Cholangitis (PBC) with Secondary Nephrotic Syndrome
✅ Management:
- Ursodeoxycholic Acid (UDCA) for cholestasis
- ACE Inhibitors for proteinuria
- Diuretics (Spironolactone) for edema
⚠️ CASE 3: ACUTE PANCREATITIS WITH SECONDARY KIDNEY INJURY
📌 Clinical Scenario:
A 38-year-old male with a history of gallstones presents with severe epigastric pain radiating to the back, nausea, vomiting, and oliguria.
📊 KFT & LFT REPORTS:
| Test | Value | Normal Range | Interpretation |
|---|
| Serum Lipase | 780 U/L | <160 U/L | Severe pancreatitis |
| ALT (SGPT) | 130 U/L | 7 – 56 U/L | Biliary obstruction |
| AST (SGOT) | 110 U/L | 10 – 40 U/L | Hepatocellular injury |
| Bilirubin (Total) | 2.2 mg/dL | 0.1 – 1.2 mg/dL | Cholestasis |
| Creatinine | 3.0 mg/dL | 0.6 – 1.2 mg/dL | Acute kidney injury (AKI) |
| BUN | 58 mg/dL | 7 – 20 mg/dL | Prerenal azotemia |
| Calcium (Serum) | 6.5 mg/dL | 8.5 – 10.5 mg/dL | Saponification (Fat Necrosis) |
📝 Diagnosis:
- Acute Pancreatitis (Gallstone-Induced) with Secondary Acute Kidney Injury
✅ Management:
- Aggressive IV Fluids (Ringer’s Lactate) for AKI
- NPO (Nil per Os) + NG Tube for pancreatitis
- Pain Control (IV Opioids) & Electrolyte Correction
🔬 CLINICAL INTEGRATION OF KFT & LFT IN GI DISORDERS
| Condition | KFT Findings | LFT Findings |
|---|
| Hepatorenal Syndrome (HRS) | ↑ Creatinine, ↓ Urine Sodium | ↑ Bilirubin, ↑ INR, ↑ Ammonia |
| Primary Biliary Cholangitis (PBC) + Nephrotic Syndrome | ↑ Creatinine, Proteinuria | ↑ ALP, ↑ GGT, ↑ Bilirubin |
| Acute Pancreatitis with Kidney Injury | ↑ Creatinine, ↑ BUN | ↑ ALT, ↑ AST, ↑ Lipase |
📌 FOR CLINICAL PRACTICE
- In cirrhosis, monitor both KFT & LFT to detect hepatorenal syndrome early.
- Cholestatic diseases (e.g., PBC) can cause secondary renal dysfunction.
- Acute pancreatitis can cause AKI due to hypovolemia and systemic inflammation.
Total Number of Words: 390
Total Reading Time: 1 minutes 58 seconds