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Prevalence of impaired renal function in patients of liver cirrhosis with or without spontaneous bacterial peritonitis

Background: Renal Impairment (RI) is a common complication in patients with liver cirrhosis and ascites. Spontaneous Bacterial Peritonitis (SBP) a complication in cirrhosis further aggravates and worsens the scenario. Blood urea nitrogen (BUN)/creatinine ratio (BCR) is one of the common laboratory tests used to distinguish prerenal azotemia (PR) from acute tubular necrosis and proves to be handy in absence of other tests. 
Objective: To find the prevalence of renal impairment in the patients of liver cirrhosis with or without SBP. 
Design and Setting: Observational, prospective, single centre study. 
Methods: Cirrhotic patients with SBP or low Ascitic fluid protein were enrolled. RI was considered if the serum creatinine or urea or both were above the reference range. BCR was obtained for each patient and divided based on BCR <20 and BCR>20. Assessment of variability of BCR values was done by further dividing them into eight subgroups (<10, 10–15, 16–20, 21–25, 26–30, 31–35, 36-40 and >40). 
Results: 34 patients were enrolled and divided into two groups. Group A with 22 patients with SBP and group B with 12 patients with low ascitic fluid protein. Group A had 77.27% patients with RI and group B had 58.33%. Majority of the patients had BCR>20 group denoting a RI of PR type. Three patients had BCR>40 indicating towards a probable gastrointestinal haemorrhage. 
Conclusion: This study gives an idea about the common occurrence of renal impairment in the patients of liver cirrhosis and ascites which needs early intervention to improve the prognosis.   
Keywords: Renal Impairment; Renal failure; Blood urea nitrogen creatinine ratio; BCR Spontaneous Bacterial Peritonitis; Liver cirrhosis