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Review
. 2021 May 28;13(5):e15287.
doi: 10.7759/cureus.15287.

Meta-Analysis and Systematic Review of Primary Renal Tubular Acidosis in Patients With Autoimmune Hepatitis and Alcoholic Hepatitis

Eyad Gadour  1 , Tamer Mohamed  2 , Zeinab Hassan  3   4 , Abdalla Hassan  1
Affiliations
Review

Meta-Analysis and Systematic Review of Primary Renal Tubular Acidosis in Patients With Autoimmune Hepatitis and Alcoholic Hepatitis

Eyad Gadour et al. Cureus. .

Abstract

Renal and hepatic functions are often mingled through both the existence of associated primary organ diseases and hemodynamic co-relationship. The primary objective of this study was to sum up the relationship between autoimmune hepatitis (AIH) on renal tubular acidosis (RTA) and the stages of the disease. A systematic review was performed for 24 trials. A total of 3687 patients were included. The incidence of RTA occurring and short-term mortality reduction was seen in two groups; for an overall effect: Z = 2.85 (P = 0.004) a total 95% CI of 0.53 [0.34, 0.82]. Only one patient with alcoholic liver cirrhosis was found to have an incomplete type of RTA. Test for overall effect: Z = 2.28 (P = 0.02) 95% CI of 2.83 [1.16, 6.95]. A reduction in fatal infections with dual therapy of corticosteroid plus N-acetylcysteine (NAC) test for overall effect: Z = 3.07 (P = 0.002) with 95% CI of 0.45 [0.27, 0.75]. Autoimmune diseases are the most frequent underlying cause of secondary RTA in adults. The primary renal disease must be actively excluded in all patients with hepatic failure by aggressive clinical and laboratory evaluations.

Keywords: autoimmune hepatitis; end-stage liver disease; liver cirrhosis; renal failure; renal tubular acidosis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Prisma flow diagram
Figure 2
Figure 2. Inpatient mortality or prolonged hospitalization in correlation to Child-Pugh score
Figure 3
Figure 3. Group 1, Section 1 (short-term mortality)
Figure 4
Figure 4. Group 1, Section 2. N-Acetylcysteine vs Placebo
Figure 5
Figure 5. Group 1, Section 3. Pentoxifylline vs Placebo
Figure 6
Figure 6. Group 2, Section 1. Corticosteroid vs Pentoxifylline
Figure 7
Figure 7. Group 2, Section 2. Corticosteroid vs N-Acetylcysteine
Figure 8
Figure 8. Group 3, Section 1. Corticosteroid + Pentoxifylline vs Corticosteroid alone
Figure 9
Figure 9. Group 3, Section 2. Corticosteroid + Pentoxifylline vs Pentoxifylline
Figure 10
Figure 10. Group 3, Section 3. Corticosteroid + N-Acetylcysteine vs Corticosteroid alone
Figure 11
Figure 11. Secondary outcome A: risk of fatal hemorrhage
Figure 12
Figure 12. Secondary outcome B: risk of fatal infections and sepsis
See this image and copyright information in PMC

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