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Renal dysfunction is common in Cirrhosis and accurate assessment of renal function particularly important because in advanced cirrhosis it helps as it helps us to decide that whether the patient will be considered for simultaneous liver kidney or liver transplant alone. Apart from this, the presence of renal dysfunction portends worse survival outcomes in cirrhosis. We already know that in cirrhosis there in enormous amount of sarcopenia which reduces accuracy of creatinine-based equations for renal assessment markedly. Cystatin-C has been tried and has been found better then creatinine in many studies but it also has some fallacies. A gold standard for measurement of GFR Is Iohexol clearance. Another alternative method that has been described in literature is using DTPA. DTPA also has two methods for measurement that is camera method which is frought with fallacies due to presence of ascites and fluid overload and a plasma clearance method. GFR varies by ethnicity. Here we present 5 cases where simultaneous estimated GFR (eGFR) and measured GFR (mGFR) was done in cirrhosis patients with Asian (Indian) ethnicity.
Consecutive 5 pts in whom creatinine estimation, DTPA plasma clearance and camera method as Iohexol was reported in the study. For DTPA patient received DTPA immediately camera images were taken, then samples were taken for assessment of activity of DTPA and GFR were calculated based on their clearance of it. For Iohexol GFR, Iohexol weight-based dosage was given and timed samples were taken to measure iohexol clearance and mGFR was determined. The eGFR Calculator https://www.kidney.org/professionals/KDOQI/gfr_calculator were used to derive eGFR by different formulae.
The etiologies of cirrhosis in study Participants were chronic hepatitis B (n = 1), chronic hepatitis C (n = 1), and Alcoholic liver disease (n=2), Non – alcoholic steatohepatitis (1). The baseline characteristics have been shown in Table 1 below.
Table No. 1 Patient Characteristics
Variables
Patient 1
Patient 2
Patient 3
Patient 4
Patient 5
Age (yrs)
42
56
38
47
59
Gender
Female
Male
Billi Total
0.49
0.77
0.69
0.93
0.41
SGOT
43.1
36.6
52.1
62.5
27.29
SGPT
32.2
35.5
46.5
31.18
ALP
94
116
105
132
52.24
Alb
4.29
4.87
4.46
4.2
INR
1.02
0.99
1.43
0.94
1.03
Na
137
129
135
141
139.8
Urea
30.4
40.4
19
39.2
This case series demonstrates that the estimated GFR and measured GFR are different in cirrhosis patients and there is urgent need to evaluate most accurate and practical method to determine GFR that will be crucial in management of patients with cirrhosis. We are conducting Iohexol clearance GFR in Indian patients’ cirrhosis and this will be instrumental in establishing true GFR in this population.