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LETTER TO EDITOR
Year : 2020  |  Volume : 7  |  Issue : 2  |  Page : 56-57

What is the serum creatinine level cutoff for starting of complications in nonalcoholic fatty liver disease?


Department of Pediatric Nephrology, Pediatric Ward Sevome Shaban Hospital, Tehran, Iran

Date of Submission24-Mar-2020
Date of Decision30-Nov-2020
Date of Acceptance25-Jan-2021
Date of Web Publication25-Aug-2021

Correspondence Address:
Majid Malaki
Department of Pediatric Nephrology, Pediatric Ward Sevome Shaban Hospital, Tehran
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jina.jina_2_20

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How to cite this article:
Malaki M. What is the serum creatinine level cutoff for starting of complications in nonalcoholic fatty liver disease?. J Integr Nephrol Androl 2020;7:56-7

How to cite this URL:
Malaki M. What is the serum creatinine level cutoff for starting of complications in nonalcoholic fatty liver disease?. J Integr Nephrol Androl [serial online] 2020 [cited 2021 Dec 7];7:56-7. Available from: http://www.journal-ina.com/text.asp?2020/7/2/56/324507



Dear Editor,

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of abnormal liver function test, and one-third of population may be affected to NAFLD.[1] Many authors have concluded that NAFLD plays a pathogenic role in the development of chronic kidney disease (CKD), and the severity of liver disease is associated with both increased risk and severity of CKD.[2] This study tries to compare fatty liver disease with acceptable renal function and mild-to-moderate renal dysfunction. In this study, 55 cases affected to fatty liver diagnosed by ultrasound were divided into two groups: serum creatinine (SCr) higher than 1.5 mg/dl and lower/equal than 1.5 mg/dl as normal renal function; the Patients' age under 30 and severe renal disease and liver dysfunction includes cirrhosis were excluded, and comparison was done by Mann–Whitney U-test and Chi-square test; P < 0.05 was statistically significant. The age of entered cases was 50 ± 12 years. Nearly 89% of cases had SCr under 1.5 mg/dl and their mean ± standard deviation (SD) of SCr was 1 ± 0.19 mg/dl, while 11% of cases had high SCr (>1.5 mg/dl) which their mean ± SD of their creatinine was 2.3 ± 0.5 mg/dl. The laboratory tests were compared between these two groups that show blood urea increase significantly if SCr goes beyond of 1.5 mg/dl, CKD cannot effect on the liver function test results. Hemoglobin A1C increases in CKD group, and high rate of diabetics among CKD patients with fatty liver disease was prominent (50% of patients, likelihood ratio: 15.3, P = 0.001); the other parameters such as serum phosphor level, calcification coefficient, and parathyroid hormone were higher significantly in CKD group (SCr >1.5 mg/dl) compared to normal renal function (creatinine ≤1.5 mg/dl) with coexisting fatty liver disease [Table 1]. Normal SCr should be less than 1.5 mg/dl in adults without regarding to gender and age; the (SCr) levels higher than 4 mg/dl can indicate serious impairment in renal function.[3] Association of CKD and fatty liver disease has been focused earlier by some studies[4] and show importance of this association is related to high prevalence of NAFLD that is reported to be 8%–45% in the general population. NAFLD is referred to a wide spectrum of liver damage, ranging from simple steatosis to nonalcoholic steatohepatitis, advanced fibrosis, and cirrhosis. NAFLD is the underlying cause of increasing number of extrahepatic complications such as Type II diabetes mellitus and cardiovascular disease, as well CKD. In addition, there is a problem face to studies working on relation of liver disease and kidney dysfunction, and they found that measured glomerular filtration rate and SCr in NAFLD may be biased back to impairment of creatinine synthesis by liver and underestimate CKD in fatty liver disease.[4] In fact, safe level of SCr in NAFLD should be redefined separately based on consequences of SCr on other laboratory tests, but there is not a cutoff SCr level that demonstrates the early alert sign of appearance of CKD in such patients. This study shows that the metabolic (increase serum urea), diabetes mellitus Ttype 2 and hyperparathyroidism include increase phosphor, and calcium coefficient and increase parathormone hormone were higher significantly in SCr over 1.5mg/dl that all can herald for cardiovascular complications and bone osteodystrophy in future.
Table 1: The comparison of laboratory tests in fatty liver disease with chronic kidney disease and without chronic kidney disease based on defined of the serum creatinine cut-off level

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NAFLD is associated with CKD (creatine >1.5 mg/dl) in 11% of cases. This group of patients show increase parathormone and phosphor level and higher calcification coefficient and high urea level compared to cases with lower creatinine level (≤1.5 mg/dl). This study shows in fatty liver cases with creatinine level higher than 1.5 mg/dl, nutritional consideration, and medical management should be started to lower serum urea and phosphor level for prevention of further complications.

Acknowledgment

I dedicate this study to soul of Dr Mohammad Mosadegh, god bless his soul.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Targher G, Francque SM. A fatty liver leads to decrease renal function? J Hepatol 2017;67:1137-9.  Back to cited text no. 1
    
2.
Pacifico L, Bonci E, Andreoli GM, Di Martino M, Gallozzi A, De Luca E, et al. The impact of nonalcoholic fatty liver disease on renal function in children with overweight/obesity. Int J Mol Sci 2016;17:1218.  Back to cited text no. 2
    
3.
Available from: https://www.ebmconsult.com/articles/lab-test-creatinine-urine-level. [Last accessed on 2020 Mar 05].  Back to cited text no. 3
    
4.
Kiapidou S, Liava C, Kalogirou M, Akriviadis E, Sinakos E. Chronic kidney disease in patients with non-alcoholic fatty liver disease: What the Hepatologist should know? Ann Hepatol 2020;19:134-44.  Back to cited text no. 4
    



 
 
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