Hepatitis A is generally regarded as a mild, self-limiting disease of the liver. Acute renal failure has rarely been reported in association with non-fulminant acute hepatitis A. Acute tubular necrosis is the most common form of renal injury in such patients. We recently experienced two cases of hepatitis A in which acute renal failure occurred early in the course of the illness and had a clinical course suggestive of acute tubular necrosis. In both patients, the clinical course of renal dysfunction was almost parallel to that of hepatic dysfunction. Hemodialysis was performed in patient 1 because of severe uremia despite maintaining urine output more than 2,000 mL per day. On the other hand, hemodialysis was not performed in patient 2 who showed a rapid recovery of renal dysfunction. The renal biopsy of patient 1 demonstrated typical findings of acute tubular necrosis on microscopy.
Acute Disease ; Adult ; Hepatitis A/complications/*diagnosis/pathology ; Humans ; Kidney Failure, Acute/complications/*diagnosis/pathology ; Male ; Renal Dialysis/methods

Hepatitis A is generally known as a mild, self-limiting disease of the liver, but in rare instances it can progress to fulminant hepatitis, which may require liver transplantation for recovery. Such cases are known to be related to old age and underlying liver disease. We report four cases of hepatitis A in which patients presented with fulminant hepatitis and acute renal failure and underwent liver transplantation. The following common features were observed in our cases: (1) occurrence in relatively old age (> or =39 years old), (2) association with acute renal failure, (3) presence of hepatomegaly, and (4) microscopic features of submassive hepatic necrosis.
Adult ; Age Factors ; Female ; Hepatitis/complications/*diagnosis/therapy ; Hepatitis A/complications/*diagnosis ; Hepatomegaly/diagnosis/etiology ; Humans ; Kidney Failure, Acute/complications/*diagnosis ; Liver/pathology ; Liver Cirrhosis/diagnosis/etiology ; *Liver Transplantation ; Male ; Tomography, X-Ray Computed