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Hepatitis and Kidney Disease: ‘Prevention is better than cure’

Liver and Kidney are closely related as the toxins produced in the liver are excreted by the kidney

Post by on Saturday, August 6, 2022

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World Hepatitis Day is celebrated every year on 28thJuly every year to create awareness about Hepatitis. Liver and Kidney  are closely  related as the toxins produced in the liver are excreted by the kidney.   Hepatitis is characterised by inflammation of the liver and liver damage.  This can also affect the kidney.

 

There are different types of kidney damage in hepatitis:

 

Acute Kidney Injury: this usually occurs in Acute Viral hepatitis due to all types of hepatitis viruses A,B,C, D and E. It is managed mainly by supportive therapy in form of hydration and treatment of underlying liver disease and the kidney damage usually recovers completely. The more severe the liver damage the greater is the degree of kidney damage. Hence these patients should be managed by an expert team of Liver and Kidney specialists.

 

Glomerulonephritis: This means inflammation of the kidney filters or glomeruli. This is usually seen in Hepatitis B and Hepatitis C infections. There is immune mediated damage and inflammation of kidney filters. This results in leakage of blood and protein in urine and rise of urea and creatinine. If diagnosed in time chronic kidney damage can be prevented. Hence these patients should immediately see a nephrologist and preferably get a kidney biopsy done. Treatment consists of use of antivirals along with immunosuppressive agents if indicated.

 

Hepatorenal syndrome: This usually happens with severe liver damage which in turn causes kidney damage. In the early stages it can be managed with medicines but quite often liver transplant is requires. In the late stages with severe kidney disease sometimes a  combined liver and kidney transplant .

 

Of the various types of hepatitis, kidney damage is more common with Hepatitis B and hepatitis C. Both these infections are transmitted via shared syringes (uncommon now) infected body fluids and blood transfusions. Hence patients on Hemodialysis are at high risk of getting these infections. These can have disastrous effect on patients planned for kidney transplant. These patients are higher risk of developing severe infections (sepsis). These patients can also develop Diabetes following kidney transplant and have a shorter life of the transplanted kidney.  It is mandatory to periodically screen all Dialysis patients for Hepatitis B and Hepatitis C infections. There are very effective antiviral drugs available for both Hepatitis B and Hepatitis C infection and they can prevent liver damage if diagnosed early. However these drugs are expensive and require regular monitoring. 

 

Thus the age old adage “Prevention is better than Cure holds true for Hepatitis B and C. There is a very effective vaccine available against Hepatitis A and Hepatitis B viruses.  It is important to complete the vaccination against these viruses during childhood along with other vaccines. However we frequently see patients with kidney disease who are either not vaccinated or have low antibodies.   It is important to note that patients with Chronic Kidney Disease require higher doses of the Hepatitis B vaccine.  There is no vaccine yet against Hepatitis C.

 

The most effective methods for preventing  Hepatitisin Dialysis patients is to avoid blood transfusions and ensuring strict Universal precautions and hand hygiene amongst the Dialysis staff. The patients should be careful in selecting a good Dialysis Unit where such practices are followed even if it means paying a little extra, as in the long term it is cheaper than taking medicines for these infections and risk of infections and repeated hospitalizations. 

 

For more information on this aspect and other kidney diseases please see my YouTube Channel Dr Sanjeev Gulati Kidney Clinic.

 

 

(The Author is President Elect Indian Scoiety of Nephrology, Principal Director, Nephrology and Kidney Transplant Fortis Hospital, NCR)

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