Acute A viral hepatitis is a mild, self-limiting disease of liver and acute renal failure (ARF) is a rare complication. We report two cases of chronic renal failure (CRF) in nonfulminant acute A viral hepatitis and ARF. A 40-year-old man was admitted with ARF and acute A viral hepatitis, and underwent temporary hemodialysis therapy. The renal biopsy showed acute tubular necrosis with tubulointerstitial nephritis. At 13 months after discharge serum creatinine was 1.33 mg/dL and protein-creatinine ratio of spot urine was 0.47 (mg/mg Cr). The second case was a 28-year-old man and was managed conservatively. At discharge the serum creatinine was 3.14 mg/dL and the urinalysis showed hematuria, and protein-creatinine ratio 0.56 (mg/mg Cr). Thirty-nine months after discharge, the creatinine was 1.23 mg/dL, the urinalysis showed persistent nephritis findings and the protein-creatinine ratio 1.28. Kidney biopsy revealed the membranous glomerulopathy with mild tubulointerstitial nephritis, and all of findings suggested the systemic disease-associated secondary glomerulopathy. To our knowledge our case is the first one of chronic glomerulapathy that is confirmed by kidney biopsy.
Acute Kidney Injury ; Adult ; Biopsy ; Creatinine ; Glomerulonephritis ; Glomerulonephritis, Membranous ; Hematuria ; Hepatitis ; Humans ; Kidney ; Kidney Failure, Chronic ; Liver ; Necrosis ; Nephritis ; Nephritis, Interstitial ; Renal Dialysis ; Urinalysis

PURPOSE: Metastatic biliary tract cancer (mBTC) has a dismal prognosis. In this study, an independent dataset of patients with mBTC was used to implement and validate a routine clinico-laboratory parameter-based scoring model for risk group identification. MATERIALS AND METHODS: From September 2006 to February 2015, 482 patients with mBTC were assigned randomly (ratio, 7:3) into investigational (n=340) and validation datasets (n=142). The continuous variables were dichotomized using a normal range or the best cutoff values determined using the Contal and O'Quigley statistical methods. Following a Cox’s proportional hazard model, the scoring model was derived by summing the rounded chi-square scores for the factors identified by multivariate analysis. RESULTS: The performance status (Eastern Cooperative Oncology Group 3-4), hypoalbuminemia (< 3.4 mg/dL), carcinoembryonic antigen (≥ 9 ng/mL), neutrophil-to-lymphocyte ratio (≥ 3.0), and carbohydrate antigen 19-9 (≥ 120 U/mL) were identified as independent prognosticators (Harrell’s C index, 0.682; integrated area under the curve, 0.653). Survival was clearly correlated with the risk groups (low, intermediate, and high, 14.0, 7.3, and 2.3 months, respectively; p < 0.001). The prognosis was also discriminative in the validation data set (median survival, 16.7, 7.5, and 1.9 months, respectively; p < 0.001). Chemotherapy did not offer any survival benefits for high-risk patients. CONCLUSION: These proposed prognostic criteria for mBTC can facilitate accurate patient risk stratification and treatment-related decision-making.
Biliary Tract Neoplasms* ; Biliary Tract* ; Carcinoembryonic Antigen ; Dataset ; Drug Therapy ; Humans ; Hypoalbuminemia ; Multivariate Analysis ; Prognosis ; Proportional Hazards Models ; Reference Values ; Social Identification