Acute kidney and liver damage in chronic alcohol intoxication

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Background. Alcoholism is a serious medical, social and economic problem of the 21st century. Regular alcohol consumption in a dose of 60-80 g/day or at least three times a week or a single consumption of ≥300 ml of vodka increases the risk of developing structural and functional changes in the kidneys, liver, pancreas, central nervous system and heart. Acute kidney injury (AKI) is a widespread polyetiological syndrome characterized by a sharp decrease in renal filtration (hypercreatininemia, decreased glomerular filtration rate, decreased diuresis). In alcohol intoxication, liver damage of varying severity is often detected, and the presence of AKI worsens the prognosis of the disease. However, with timely diagnosis and adequate therapy, AKI is reversible in most cases.

Description of the clinical case. The article considers a case of liver damage complicated by AKI in an elderly patient with obesity who had been abusing alcohol for a long time. According to the clinical and laboratory examination conducted at the time of hospitalization and during treatment, the following changes in peripheral blood parameters were noted: leukocytes (24,6×10⁹/l → 7,5×10⁹/l), platelets (603×10⁹/l → 446×10⁹/l), C-reactive protein (240,7 mg/l → 95,7 mg/l), γ-glutamyl transpeptidase (372 U/L → 175 U/L), alanine aminotransferase (49,1 U/l → 27,3 U/l), D-dimer (2,54 → 3,21), creatinine (146 μmol/l → 90 μmol/l), glomerular filtration rate (43 ml/min → 80 ml/min). In addition, the patient had elevated fibrinogen, ferritin, thyroid-stimulating hormone, cystatin C, and rheumatoid factor levels. According to FibroScan, grade F2 liver fibrosis was diagnosed. Instrumental examination revealed atherosclerotic lesions of the carotid and femoral arteries, left ventricle diastolic dysfunction, left atrium dilation, as well as non-erosive gastroesophageal reflux disease and erosive lesions of the gastric mucosa. The article also discusses the mechanisms of kidney and liver damage in chronic alcohol intoxication.

Full Text

Restricted Access

About the authors

Ilkhom T. Murkamilov

Kyrgyz State Medical Academy named after I.K. Akhunbaev; Salymbekov University

Author for correspondence.
Email: murkamilov.i@mail.ru
ORCID iD: 0000-0001-8513-9279

Dr.Sci. (Med.), Corresponding Member of the Russian Academy of Natural Sciences, Associate Professor at the Department of Faculty Therapy, Director of the Multidisciplinary Medical Center "Doc University Clinic"

Kyrgyzstan, Bishkek; Bishkek

Kubanych A. Aitbaev

Salymbekov University

Email: aitbaev.kuban1940@gmail.com
ORCID iD: 0000-0003-4973-039X

Dr.Sci. (Med.), Professor, Consultant to the Department of Intensive Care Medicine, Therapy and Diagnostics

Kyrgyzstan, Bishkek

Viktor V. Fomin

Russian Medical Academy of Continuous Professional Education

Email: fomin_vic@mail.ru
ORCID iD: 0000-0002-2682-4417

Dr.Sci. (Med.), Professor, Academician of the Russian Academy of Sciences, Rector

Russian Federation, Moscow

Zhamila A. Murkamilova

Family Medicine Center №7

Email: murkamilovazh.t@mail.ru
ORCID iD: 0000-0002-7653-0433

therapist

Kyrgyzstan, Bishkek

Zafarbek R. Raimzhanov

N.N. Burdenko Main Military Clinical Hospital

Email: rzrmam@mail.ru
ORCID iD: 0000-0001-5746-6731

neurologist

Russian Federation, Moscow

Jaloliddin I. Solizhonov

Republican Specialized Scientific and Practical Medical Center for Nephrology and Kidney Transplantation

Email: jaloliddinsolijonov44@gmail.com
ORCID iD: 0009-0003-0078-0609

clinical resident

Uzbekistan, Tashkent

Abdulhokim F. Yusupov

Osh State University

Email: zulkhumor.yusupova.f_05@mail.ru
ORCID iD: 0000-0002-6449-8229

research physician, Department of Neurology, Neurosurgery and Psychiatry, Medical Faculty

Kyrgyzstan, Osh

Furkat A. Yusupov

Osh State University

Email: furcat_y@mail.ru
ORCID iD: 0000-0003-0632-6653

Dr. Sci. (Med.), Professor, Head of the Department of Neurology, Neurosurgery and Psychiatry, Medical Faculty

Kyrgyzstan, Osh

Tursunoy F. Yusupova

Osh State University

Email: yusupova_tursunoy_f@mail.ru
ORCID iD: 0000-0002-8502-2203

Clinical Resident of the Department of Neurology, Neurosurgery and Psychiatry, Medical Faculty

Kyrgyzstan, Osh

Komil K. Khabibullaev

Kyrgyz State Medical Academy named after I.K. Akhunbaev

Email: khabibullaevkomil2001@gmail.com
ORCID iD: 0009-0004-5508-8019

6th-year student of the Faculty of Medicine

Kyrgyzstan, Bishkek

References

  1. Sohi I., Franklin A., Chrystoja B. et al. The Global Impact of Alcohol Consumption on Premature Mortality and Health in 2016. Nutrients. 2021;13(9):3145. doi: 10.3390/nu13093145.
  2. Ritchie H., Roser M. Alcohol consumption. Our world in data. 2022.
  3. Matarazzo A., Hennekens C.H., Dunn J. et al. New Clinical and Public Health Challenges: Increasing Trends in United States Alcohol Related Mortality. Am. J. Med. 2025;138(3):477–86. doi: 10.1016/j.amjmed.2024.10.024.
  4. Кайгородова Т.В., Куликов А.А. Подходы Всемирной организации здравоохранения к борьбе со злоупотреблением алкоголем. Социальные аспекты здоровья населения. 2010;14(2):9. [Kaygorodova T.V., Kulikov A.A. Approaches of the World Health organization to the fight against alcohol abuse. Social aspects of public health. 2010;14(2):9 (In Russ).].
  5. Александровский В.Н., Остапенко Ю.Н., Гольдфарб Ю.С. и др. Острое отравление этиловым алкоголем (алкогольная кома). Журн. им. Н.В. Склифосовского. Неотложная медицинская помощь. 2018;7(4):357–65. [Alexandrovsky V.N., Оstapenko Y.N., Goldfarb Y.S., et al. Acute poisoning with ethyl alcohol (alcoholic coma). Rus. Sklifosovsky J. Emerg. Med. Care. 2018;7(4):357–65 (In Russ.)]. doi: 10.23934/2223-9022-2018-7-4-357-365.
  6. Никоноф В.В., Курсов С.В., Феськов А.Э. и др. Случай сочетания токсической кардиомиопатии, осложненной кардиогенным шоком, и синдрома позиционного сдавливания с острой почечной недостаточностью. Медицина неотложных состояний. 2014;1(56):98–100. [Nikonov V.V., Kursov S.V., Feskov A.E. et al. A case of a combination of toxic cardiomyopathy complicated by cardiogenic shock and positional compression syndrome with acute renal failure. Emerg. Med. 2014;1(56):98–100 (In Russ.)].
  7. Шкодкин И.В., Ягашкина С.И. Поражение сердца и внутренних органов при алкогольной интоксикации. причины летальных исходов. Здоровье – основа человеческого потенциала: проблемы и пути их решения. 2017;12(2):534–44. [Shkodkin I.V., Yagashkina S.I. Damage to the heart and internal organs during alcohol intoxication. causes of deaths. Health is the basis of human potential: problems and ways to solve them. 2017;12(2):534–44 (In Russ.)].
  8. Муркамилов И.Т., Сабиров И.С., Юсупов Ф.А. и др. Токсическое и метаболическое поражения почек: в фокусе энергетические напитки. Бюлл. науки и практики. 2024;10:9:232–44. [Murkamilov I., Sabirov I., Yusupov F. et al. Toxic and Metabolic Kidney Injury: Focus on Energy Drinks. Bull. Sci. Pract. 2024;10:9:232–44 (In Russ.)]. Doi: 10.33619/ 2414-2948/106/26.
  9. Югай К.С., Бейникова И.В., Снытина В.А. и др. Механизмы повреждения почек при отравлении суррогатами алкоголя. Соврем. пробл. науки и образования. 2016;2:45–5. [Yugay K.S., Beinikova I.V., Snytina V.A. et al. The mechanisms of kidney damage induced by surrogate alcohol. Mod. Probl. Sci. Educat. 2016;2:45–5 (In Russ.)].
  10. Tanaka A., Yamaguchi M., Ishimoto T. et al. Association of alcohol consumption with the incidence of proteinuria and chronic kidney disease: a retrospective cohort study in Japan. Nutr. J. 2022;21(1):31. Doi: 10.1186/ s12937-022-00785-x.
  11. Ермоленко В.М., Николаев А.Ю. Острая почечная недостаточность. 2-е изд-е. М., 2017. С. 237. [Ermolenko V.M., Nikolaev A.Y. Acute renal failure. 2nd ed. M., 2017. 237 p. (In Russ.)].
  12. Набатчикова Е.А., Абдурахманов Д.Т., Никулкина Е.Н. и др. Оценка фиброза печени методом транзиентной эластометрии у пациентов с циррозом печени после элиминации вируса гепатита С. Сеченовский вестник. 2020;11(1):26–37. [Nabatchikova E.A., Abdurakhmanov D.T., Nikulkina E.N. et al. Liver fibrosis assessment by transient elastography in patients with liver cirrhosis after hepatitis C virus eradication. Sechenov Med. J. 2020;11(1):26–37 (In Russ.)]. Doi: 10.47093/ 2218-7332.2020.11.1.26-37.
  13. Клинические рекомендации. Хроническая болезнь почек (ХБП). Нефрология. 2021;25(5):10–82. [Clinical recommendations. Chronic kidney disease (CKD). Nephrology. 2021;25(5):10–82 (In Russ.)]. doi: 10.36485/1561-6274-2021-25-5-10-82.
  14. Гуревич М.А., Кузьменко Н.А. Алкогольное поражение сердца. РМЖ. 2016;19:1281–4. [Gurevich M.A., Kuzmenko N.A. Alcoholic heart disease. breast cancer. RMJ. 2016;19:1281–4 (In Russ.)].
  15. Sanchez-Roige S., Palmer A.A., Fontanillas P., Elson S.L.; 23.and.Me Research Team, the Substance Use Disorder Working Group of the Psychiatric Genomics Consortium; Adams M.J., Howard D.M., Edenberg H.J., et al. Genome-Wide Association Study Meta-Analysis of the Alcohol Use Disorders Identification Test (AUDIT) in Two Population-Based Cohorts. Am. J. Psych. 2019;176(2):107–18. doi: 10.1176/appi.ajp.2018.18040369.
  16. Николаев А.Ю., Малкоч А.В. Регулярное употребление алкоголя: высокий риск хронической алкогольной интоксикации, проблематичность протективных эффектов. Леч. врач. 2020;5:17–21. [Nikolaev A.Yu., Malkoch A.V. Regular alcohol ingestion: high risk of chronic alcohol intoxication, controversy of protective effects. Lech. Vrach. (The Attending Physician). 2020;5:17–21 (In Russ.)]. doi: 10.26295/OS.2020.81.39.003.
  17. Hoyt J.E., Teja N., Jiang T., et al. Changes in Alcohol Consumption following Direct-Acting Antiviral Treatment for Hepatitis C in VA Patients with Comorbid Alcohol Use Disorder and PTSD. J. Dual. Diagn. 2022;18(4):185–98. doi: 10.1080/15504263.2022.2123119.
  18. Haque L.Y., Fiellin D.A., Tate J.P. et al. Association Between Alcohol Use Disorder and Receipt of Direct-Acting Antiviral Hepatitis C Virus Treatment. JAMA. Netw Open. 2022;5(12):e2246604. doi: 10.1001/jamanetworkopen.2022.46604. [Erratum in: JAMA. Netw Open. 2023;6(1):e2253120. doi: 10.1001/jamanetworkopen.2022.53120.
  19. Лопаткина Т.Н., Танащук Е.Л., Северов М.В. Алкогольная болезнь печени. Практическая гепатология/ Под ред. Н.А. Мухина. М., 2004. С. 137–45. [Lopatkina T.N., Tanashchuk E.L., Severov M.V. Alcoholic liver disease. Practical hepatology. Ed. by N.A. Mukhin. M., 2004. Р. 137–45 (In Russ.)].
  20. Adelodun A, Abdellatief A, Babajide O. Epstein-Barr Virus Hepatitis Masquerading as Painless Jaundice. Cureus. 2022;14(10):e30333. doi: 10.7759/cureus.30333.
  21. Тарасова О.И., Огурцов П.П. Гематологические маски хронической алкогольной интоксикации. Вестн. последипломного медицинского образования. 2017;4:24–30. [Tarasova O.I., Ogurtsov P.P. Hematological masks of chronic alcohol intoxication. Bull. Postgraduat. Med. Educat. 2017;4: 24–30 (In Russ.)].
  22. Ветлугина Т.П., Савочкина Д.Н., Бойко А.С. и др. Провоспалительные цитокины при психических и поведенческих расстройствах в результате употребления алкоголя. Психиатрическая наука в истории и перспективе.2019. С. 183. [Vetlugina T.P., Savochkina D.N., Boyko A.S. et al. Pro-inflammatory cytokines in psychiatric and behavioral disorders resulting from alcohol consumption. Psych. Sci. History Perspect. 2019. P. 183 (In Russ.)].
  23. Балашова А.А., Аришева О.С., Гармаш И.В. и др. Цитокины и алкогольная болезнь печени. Клин. фармакология и терапия. 2017;26(1):41–6. [Balashova A.A., Arisheva O.S., Garmash I.V. et al. Cytokines and alcoholic liver disease. Сlin. Farmakol. Ter. 2017;26(1):41−6 (In Russ.)].
  24. Иванов А.С., Гармаш И.В., Аришева О.С. и др. Взаимосвязь полиморфных локусов, расположенных в промоторных областях генов VEGF (rs699947 и rs2010963), ICAM1 (rs281437) и ET-1 (rs1800541), с уровнем соответствующих белковых продуктов в сыворотке крови и риском развития алкогольного цирроза печени. Вестн. РАМН. 2018;73(6):368–77. [Ivanov A.S., Garmasch I.V., Arisheva O.S. et al. Association of SNPs in the Promoter Regions of VEGF (rs699947 и rs2010963), ICAM1 (rs281437) and ET-1 (rs1800541) with Serum Levels of Related Proteins and Alcoholic Liver Cirrhosis Risk. Ann. Rus. Acad. Med. Sci. 2018;73(6):368–77 (In Russ.)]. doi: 10.15690/vramn1059.
  25. Лазебник Л.Б., Тарасова Л.В., Цыганова Ю.В. и др. Клинические рекомендации по диагностике и лечению алкогольной болезни печени. www.nogr.org/index.php/rec/372-guid-14. [Lazebnik L.B., Tarasova L.V., Tsyganova Yu.V. et al. Clinical guidelines for the diagnosis and treatment of alcoholic liver disease. www.nogr.org/index.php/rec/372-guid-14 (In Russ.)].
  26. Финн Л.Л. Острая почечная недостаточность как осложнение алкогольной нефропатии. Клинический случай. Вестн. науки и образования. 2024;9(152):68–71. [Finn L.L. Acute renal failure as a complication of alcohol nephropathy. Clinical case. Bulletin of Science and Education. 2024;9(152):68–71 (In Russ.)].
  27. Pergener T.V., Whelton P.K. Risk of ESRD associated with alcohol consumption. Am. J. Epidemiol. 1999;150:1275–81.
  28. Naidu B.K, Santosh R.K., Bhaskara Rao J.V. et al. Gamma-Glutamyl Transferase as a Diagnostic Marker of Metabolic Syndrome. Cureus. 2023;15(6):e41060. doi: 10.7759/cureus.41060.
  29. Wang M., Fan X.K., Su J. et al. Association of serum gamma-glutamyl transferase levels with cardiovascular disease risk in type 2 diabetes patients: a prospective cohort study. Zhonghua Liu Xing Bing Xue Za Zhi. 2024;45(10):1339–47. Chinese. doi: 10.3760/cma.j.cn112338-20240628-00384.
  30. Ndrepepa G., Kastrati A. Gamma glutamyl transferase and cardiovascular disease. Ann. Transl. Med. 2016;4(24):481. doi: 10.21037/atm.2016.12.27.
  31. Mason J.E., Starke R.D., van Kirk J.E. Gamma-glutamyl transferase: A novel cardiovascular risk biomarker. Prev. Cardiol. 2010;13(1):36–41. doi: 10.1111/j.1751-7141.2009.00054.x.
  32. Алиева А.М., Байкова И.Е., Воронкова К.В. и др. Гамма-глутамилтранспептидаза – перспективный биологический маркер сердечной недостаточности. Клиницист. 2022;16(1):К643. [Alieva A.M., Baykova I.E., Voronkova K.V. et al. Gamma-glutamyl transpeptidase is a promising biological marker of heart failure. Сlinician. 2022;16(1):К643 (In Russ.)]. doi: 10.17650/1818-8338-2022-16-1-К643.
  33. Моисеев В.С., Николаев А.Ю. Диагностика хронической алкогольной интоксикации в кн.: Алкогольная болезнь. Поражение внутренних органов/ Под ред. В.С. Моисеева. 2-е изд., пераб. и доп. М., 2014. С. 460–9. [Moiseev V.S., Nikolaev A.Y. Diagnosis of chronic alcohol intoxication. In: Alcoholic illness. Damage to internal organs. Ed. by V.S. Moiseev. 2nd ed., perab. and supplement. M., 2014. Р. 460–9 (In Russ.)].
  34. Абдурахманов Д.Т. Алкогольный гепатит: клиническая характеристика, течение и прогноз. Фарматека. 2008;2:25–31. [Abdurakhmanov D.T. Alcoholic hepatitis: clinical characteristics, course and prognosis. Pharmateka.2008;2:25–31 (In Russ.)].
  35. Бобкова И.Н., Чеботарева Н.В., Козловская Л.В., Непринцева Н.В. Защитное действие белков теплового шока при заболеваниях почек. Клин. нефрология. 2011;6:59–66. [Bobkova I.N., Chebotareva N.V., Kozlovskaya L.V., Nieprintseva N.V. Protective effect of heat shock proteins in kidney diseases. Clin. Nephrol. 2011;6:59–66 (In Russ.)].
  36. Ковалев А.В., Никитин А.М., Романенко Г.Х., Завалишина Л.Э. Патоморфологические изменения в почках при острой и хронической алкогольной интоксикации. Судебно-медицинская экспертиза. 2022;65(1):526. [Kovalev A.V., Nikitin A.M., Romanenko G.Kh., Zavalishina L.E. Pathomorphological alterations in the kidneys in acute and chronic alcohol intoxication. Forens. Med. Expert. 2022;65(1):526 (In Russ.)]. doi: 10.17116/sudmed20226501152.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Patient К., 66 years old (front and back view)

Download (90KB)
Indexing metadata
3. Fig. 2. Dynamics of peripheral blood parameters of patient K., 66 years old

Download (188KB)
Indexing metadata
4. Fig. 3. Dynamics of blood biochemistry parameters of patient K., 66 years old

Download (245KB)
Indexing metadata
5. Fig. 4. Risk of damage to internal organs when drinking alcohol

Download (38KB)
Indexing metadata