Publication:

The spectrum of renal changes in patients with liver diseases: an immunofluorescent and light microscopic study

Background There are divergent observations on renal function tests and renal morphology in patients with liver diseases. The present study was designed (1) To study the morphological changes in kidney in patients with various types of Liver diseases; (2) To study the correlation between the renal histology, clinical and other laboratory parameters in these cases; (3) To suggest the possible mechanisms of renal injury secondary to liver diseases.

Methods This prospective study was carried out at the department of pathology of a tertiary care centre in Delhi. A total of 30 patients admitted with liver diseases were included in the study. All kidney samples were evaluated by light microscopy and immunofluorescence microscopy. The sections were stained by fluorescent labeled antisera for human IgG, IgA and IgM. Postmortem kidney biopsy from 10 patients dying of unrelated diseases served as controls.

Results Glomerular changes on light microscopy were present in twenty four patients (80%) as compared to two controls (20%). The difference was statistically significant (x2= 11.75; p<0.001). Nine out of 13 patients with severe impairment of liver function tests (LFTs) showed specific glomerulopathies whereas only one out of 17 patients with mild to moderate impairment of LFTs, showed specific glomerular lesion. It was found to be statistically significant (x2= 13.4; p<0.001). Immunofluorescent study showed the presence of immune deposits in 21 out of 30 patients (70%). IgA positivity was seen in 18 cases, IgG in 9 cases and IgM in 10 cases.

Conclusions There is a wide spectrum of morphological lesions in the kidney in patients with liver diseases. These were mainly glomerular lesions and were directly related to the severity and chronicity of liver diseases. Immune deposits were commonly present in patients with chronic liver disease.