Report of a case with fulminant hepatitis a associated with acute renal failure

Abstract

A 34-year-old male presented with fulminant hepatitis A associated with acute renal failure. The patient was admitted four days after flu-like symptoms developed. Physical examination was unremarkable except for icteric sclerae. Laboratory studies showed SGOT 10719 U/l, SGPT 5780 U/l, prothrombin time 22%, BUN 25.5 mg/dl, and creatinine 2 mg/dl. Serum complements were within normal ranges, and circulating immune complexes were not detected. Anti-HAV IgM was positive. He developed hepatic coma on the fourth hospital day, and his renal function deteriorated progressively. He was treated with hemodialysis, but there was no improvement in consciousness. Although acute liver failure improved, he died on the 74th hospital day of subendocardial infarction. Autopsy examination showed acute renal tubular necrosis. The liver was enlarged and was in the residual stage of acute hepatitis without submassive necrosis. The development of fulminant hepatitis in hepatitis A has been rare, but in recent years acute renal failure in hepatitis A has been reported. Although the mechanisms responsible for renal failure in liver diseases are uncertain but could be multifactorial, immune complex-mediated nephritis and/or endotoxemia have been considered.

Clinical features and outcomes of acute kidney injury among patients with acute hepatitis A

“…[19][20][21] In contrast, the exact mechanism of renal damage by hepatitis A is uncertain, but several mechanisms have been proposed. First, pre-renal factors, including loss of appetite, vomiting, and/or diarrhea can cause circulatory insufficiency, activating the rennin-angiotensin system and impairing renal blood flow.…”

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

“…Among the forty-eight patients, only one case developed fulminant hepatitis with hepatic coma, [4] and the others had non-fulminant hepatitis. The ages ranged from 7 to 77 (see Table 2) with a male predominance.…”

“…Third, kidney biopsies in two cases showed normal findings, implicating the possibility of hepatorenal syndrome. [14,18] However, except for one case, [4] almost all cases have non-fulminant hepatitis without hepatic failure, and most cases have high UNa. Therefore, the hypothesis of hepatorenal syndrome is not favored.…”

“…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.…”