Acute renal failure prior to the onset of hepatic encephalopathy in fulminant hepatitis

Summary: We investigated the clinical characteristics of eight patients with fulminant hepatitis who developed acute renal failure (ARF). They were divided into two groups according to the time point when ARF occurred in the course of the disease: (i) group 1 ( n =4), ARF occurred prior to the onset of hepatic encephalopathy; and (ii) group 2 ( n =4), ARF occurred after the onset of hepatic encephalopathy. All cases in group 1 had an acute type of fulminant hepatitis, whereas a subacute type was present in the patients in group 2. All cases in group 1 and two cases in group 2 were given non-steroidal antiinflammatory drugs before the onset of ARF. Urinary findings and/or renal biopsy findings suggested that acute tubular necrosis was the cause of ARF in group 1. Three patients in group 1 and none in group 2 recovered from both ARF and fulminant hepatitis. Although it is well-known that a patient with fulminant hepatic failure complicated by ARF has a poor prognosis, our findings suggest that ARF that occurs prior to the onset of hepatic encephalopathy in acute type of viral fulminant hepatitis is not a determinant of the poor prognosis, and that the prognosis will be improved by intensive care.