Hepatitis A-Induced Diabetes Mellitus, Acute Renal Failure, and Liver Failure

Abstract

A 38-year-old otherwise healthy man presented with hepatic failure (aspartate aminotransferase of 7212 U/L, alanine aminotransferase of 6629 U/L, total and direct bilirubin of 10.7 mg/dL) and acute renal failure (creatinine of 11.6 mg/dL and blood urea nitrogen of 42 mg/dL), which required hemodialysis when the creatinine increased to 21 mg/dL, with a blood urea nitrogen of 115 mg/dL, and the patient became oliguric. On admission, this patient also had a lipase of 1833 U/L, amylase of 211 U/L, glucose of 210 mg/dL, and reactive IgM antibody for acute hepatitis A. The hepatitis and acute renal failure resolved in 3 months, but this patient continues to have type II diabetes mellitus 7 years after the hepatitis A infection. This case illustrates that hepatitis A infection may be severe with liver failure, acute renal failure, and permanent diabetes mellitus as sequale of this infection.

Acute Renal Failure Associated with Acute Non-fulminant Hepatitis A: A Case Report and Review of Literature

“…However four of the patients died, [1,4,7,8] and one patient with MPGN had permanent renal insufficiency. [6] Other comorbidities included generalized tonic-clonic seizure, [9] disseminated intravascular coagulation or coagulopathy, [6,[10][11][12] type 2 diabetes mellitus, [13] and pneumococcal peritonitis. [14] In the case with generalized tonic-clonic seizure, the electroencephalography did not show the typical findings of hepatic encephalopathy, and the serum ammonia level was normal.…”

Acute renal failure associated with nonfulminant acute viral hepatitis A

“…Very rarely nonfulminant hepatitis A has lead to ARF 3–5. When such a patient develops renal failure, common causes such as sepsis, shock, drug toxicity, bacterial infections, and rhabdomyolysis should be ruled out first.…”

“…They suggested beneficial role of high dose acetylcysteine in recovery of renal function 3. Vesely et al related the peak bilirubin levels to the requirement of hemodialysis in patients who developed ARF in the setting of viral nephritis 5. There also seems to be temporal relationship between improvement of the bilirubin concentration and improvement in renal functions 56…”