Evaluation of renal functions in children with cirrhotic and noncirrhotic portal hypertension

Renal dysfunction is one of the major complications in patients with cirrhosis and portal hypertension. Correct evaluation of renal functions in patients with end stage liver disease is of great importance, since renal dysfunction is an important risk factor of prognosis in patients on transplant list. Study group composed of 25 cirrhotic, 9 noncirrhotic patients and 20 otherwise healthy control subjects who applied to Gazi University Pediatric Gastroenterology Department. Renal functions of cases were evaluated with routine renal function tests, serum cystatin C levels, urine ß2 microglobulin, serum and urine NGAL, urine KIM 1, serum and urine IL 18. Model for end stage liver disease, Child Pugh Turcotte and Baveno IV classifications were used for clinical staging. Serum BUN, creatinin, sodium levels and urine specific gravity, pH, and fractional sodium excretion which were used as routine screening did not show any significant difference between groups. Although cystatin C levels were normal in study groups, levels were significantly higher in the patient groups (p=0,031). Urine NGAL levels were significantly higher in cirrhotic group compared to control group (p=0,043), but serum NGAL did not show any significant difference between groups. Urine KIM 1 levels were found to be significantly higher in patients with noncirrhotic portal hypertension, compared to cirrhotic and control groups (p<0,0001). Serum sodium levels, urine specific gravity and serum IL 18 levels increased with increased points of MELD, Child Pugh Turcotte and Baveno IV. These correlations were statistically significant. The relationship between cholestasis and tubulopathy were evaluated: urine ß2 microglobulin levels of cirrhotic patients with bilirubin levels of ?3 mg/dl, were significantly higher compared to patients with bilirubin levels of <3 mg/dl. New biomarkers of kidney injury are helpful for evaluating renal functions and determining clinical staging in patients with cirrhotic and noncirrhotic portal hypertension, but they need to be tested in larger case series.