A study of Liver function and Renal function tests in chronic alcoholics at a tertiary health care centre

 

 

Abstract               Background: More than 3 million people died as a result of harmful use of alcohol in 2016, according a report released by the World Health Organization (WHO). This represents 1 in 20 deaths. More than three quarters of these deaths were among men. In recent years, conventional biochemical markers and potential ones have aroused the interest of researchers to study the damages caused by ethanol in liver. There is evidence that chronic alcohol consumption may cause direct damage to the kidneys. It may also indirectly alter renal function by elevating blood pressure, inducing electrolyte imbalances and inducing hyperuricaemia. Objective: To study Liver function tests and Renal function tests in chronic alcoholic patients. Methods: This is a descriptive observational study conducted among 100 confirmed cases of alcoholism. Alcoholic liver disease was diagnosed in patients with a history of significant alcohol intake for a minimum period of 10 years, physical signs of liver disease and supportive laboratory data. Results: In our study, majority were 41-50 years age group. i.e. 35 (35%). Mean age of study subjects was 44.1± 11.2 years. LFT revealed total Bilirubin level as 4.98±1.08, Direct bilirubin 3.54±2.65, ALT 50.3±18.2, AST was 121.1±43, ALP 125±41.1, GGT 52.2±15.43 and AST/ALT ratio was 2.4±0.63. RFT revealed that Blood urea level as measured to be 67.6±12.2, whereas Serum creatinine value was found to be 2.1±0.51. Conclusion: In our study Liver and Renal parameters were deranged. Excessive alcohol consumption can have profound negative effects on the kidneys and their function in maintaining the body’s fluid, electrolyte, and acid-base balance, leaving alcoholic people vulnerable to a host of Liver and kidney related health problems.

Key Word: Liver function test, Renal function test, chronic alcoholics, tertiary care centre

 

 

INTRODUCTION

More than 3 million people died as a result of harmful use of alcohol in 2016, according a report released by the World Health Organization (WHO). This represents 1 in 20 deaths. More than three quarters of these deaths were among men. Overall, the harmful use of alcohol causes more than 5% of the global disease burden.¹ The global burden of disease from alcohol exceeds that of tobacco in large part because acute consequences of alcohol use lead to death and disability in the younger years of life. There is evidence of a convergence in drinking patterns among the young, towards products marketed to youth cultures and tastes, and associated in developed countries with drinking to intoxication and with acute consequences such as motor vehicle crashes, drowning, and interpersonal violence. It also appears that young people in many countries are beginning to drink at earlier ages, while research in developed countries has found early initiation of alcohol use to be associated with greater likelihood of both alcohol dependence and alcohol-related injury later in life. ² The spectrum of liver injury varies from simple steatosis to cirrhosis, which is linked to amount of alcohol consumption. Chronic liver disease is the end result of cirrhosis characterized by nodular regeneration and extensive fibrosis. It is estimated that about 30% of heavy alcohol consumers develop cirrhosis, other factors contributed to development of alcoholic cirrhosis include sex, obesity, duration of alcohol intake, non sex linked genetic factors and cigarette smoking³. The association between alcohol consumption and renal function, however, is poorly understood. There is evidence that chronic alcohol consumption may cause direct damage to the kidneys^4,5. It may also indirectly alter renal function by elevating blood pressure⁶, inducing electrolyte imbalances⁵and inducing hyperuricaemia⁷. In one study, alcohol intake had no effect on glomerular filtration rate (GFR) and renal plasma flow⁸; however, in another study with rats, chronic ingestion led to impairment of GFR associated with renal hypertrophy⁹. In 1984, Savdie and colleagues demonstrated that drinkers had significantly higher blood pressure that non-drinkers and drinkers of two or fewer drinks per day were found to have higher serum creatinine than non-drinking control subjects. This changed, however, to decreased serum creatinine at the level of three or more drinks per day¹⁰. In a prospective study of 1658 nurses, Knight et al. ¹¹ showed that moderate alcohol intake has no long term adverse effect on renal function as assessed by calculated creatinine clearance rate (CCr) and GFR, and may in fact have a renoprotective effect in women with hypertension.

 

METHODOLOGY

Study setting: Liver function and Renal function

Study duration: 6 months

Study design: Descriptive observational study

Sample size: Total 100 male subjects in the age group of 30 to 60 years reporting to medicine OPD at our tertiary health care centre.

Study subjects: All confirmed cases of chronic alcoholism and consuming the alcohol since last 10 years and more

Inclusion criteria:

• Age between 30-60 years.
• A case of Alcoholism was diagnosed in patients with a history of significant alcohol intake for a minimum period of 10 years, physical signs of liver disease and supportive laboratory data
• Those who are willing to participate with informed consent

Exclusion criteria:

• Those who are not willing to participate in study

Data of the patients were collected by using a pretested proforma. Detailed history, general and physical examination of all patients during the above-mentioned period was collected. They all advised a battery of investigations like CBC, LFT, RFT USG and those confirmed with the disease were included in the study.

Statistical analysis plan: Data entered in MS excel sheet and analysed by using SPSS 23.0 version IBM USA. Qualitative data was expressed in terms of percentages and quantitative data was expressed in terms of mean and standard deviation.

                

RESULTS

Table 1: Distribution of subjects according to age group

 

Table 2: Distribution of subjects according to duration of consumption of alcohol

 

Table 3: Distribution of subjects according to Liver function tests

 

Table 4: Distribution of subjects according to Renal function tests

DISCUSSION

Table 1 depicts age wise distribution of study subjects. In our study out of 100 patients of chronic alcoholic patients, majority were fro 41-50 years age group. i.e. 35 (35%) This is followed by 26 (27.7%) from 51-60 years and 25% from above 60 years age group. So the most productive age group of nation is affected with alcoholism. Mean age of study subjects was 44.1± 11.2 years. Hegde S. et al¹³ observed the mean age in their study as 45 years. Suther et al¹⁴ stated mean age as 41 years. Sarin et al¹⁵ stated mean age as 43 ± 8.7 years. Table 2 shows distribution of subjects according to duration of consumption of alcohol which shows that 45% of patients were indulged in alcohol consumption since 21-30 years and 32% were consuming it since more than 30 years. Table 3 shows distribution of subjects according to Liver function tests. In our study total Bilirubin was 4.98±1.08, Direct bilirubin3.54±2.65, ALT 50.3±18.2, AST was 121.1±43, ALP 125±41.1, GGT 52.2±15.43 and AST/ALT ratio was 2.4±0.63Table 4 shows distribution of subjects according to Renal function tests. Blood urea level was measured to be 67.6±12.2, whereas Serum creatinine      value was found to be 2.1±0.51 Serum creatinine concentration is widely used as an index of renal function, but creatinine concentration measurement may be affected by factors other than GFR. GFR measurement has been well known as the gold standard of renal function assessment¹⁶ and probably the best variable for diagnosing and monitoring kidney disease. Similarly, clinicians long have noted significant kidney enlargement (i.e., nephromegaly) in direct proportion to liver enlargement among chronic alcoholic2 patients afflicted with liver cirrhosis. Laube and colleagues (1967) suggested that both cellular enlargement and cell proliferation contribute to such nephromegaly. Normally the rate of blood flow, or perfusion, (i.e., hemodynamics) through the kidneys is tightly controlled, so that plasma can be filtered and substances the body needs can be reabsorbed under optimal circumstances (see side bar). Established liver disease impairs this important balancing act, however, by either greatly augmenting or reducing the rates of plasma flow and filtration through the glomerulus. Investigators have not yet fully explained the mechanisms underlying this wide range of abnormalities, though, and have devoted little attention to alcohol’s effects on kidney hemodynamics in people who do not have liver disease.

                              

CONCLUSION

In our study Liver and Renal parameters were deranged. Excessive alcohol consumption can have profound negative effects on the kidneys and their function in maintaining the body’s fluid, electrolyte, and acid-base balance, leaving alcoholic people vulnerable to a host of Liver and Kidney related health problems.

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