Immunological aspects of acute kidney injury in patients with liver cirrhosis

Liver cirrhosis (LC) is often complicated by acute kidney injury (AKI), which is associated with high mortality.

The aim: to study the characteristics of the T- and B-immune systems in patients with LC complicated by AKI.

Material and methods. The study included a cohort of patients hospitalized for AKI that developed secondary to acute decompensation of liver cirrhosis. The comparison group consisted of patients with no renal dysfunction. Immunological testing included determination of the number of T lymphocytes, T helper/inducer cells, cytotoxic T lymphocytes, T lymphocytes expressing activation markers (HLA-DR antigen and interleukin 2 receptor), B lymphocytes, levels of IgM, IgG, IgA, circulating immune complexes (CIC), rheumatoid factor and antibodies to thyroid peroxidase (anti-TPO).

Results. In patients with AKI, an increase of IgG, IgA and CIC levels was observed comparatively to the group of healthy individuals. Patients of the compared group without AKI, had increased indexes of B cells, IgG, IgA, IgM and CIC. Patients with AKI had significantly higher levels of IgA, CIC, and anti-TPO, but lower IgM values relatively to the comparison group. As concerning T-system of immunity, an increase of the amount of T helper cells, activated cells and the value of the immunoregulatory index was fixed in the group of patients with the absence of AKI, in comparison with the group of healthy participants, while among patients with AKI only one index was increased – the level cytotoxic T lymphocytes in addition to immunoregulatory index decrease.

Conclusion. In contrast to the group of patients with cirrhosis without AKI, patients with such kind of complication showed a decrease in the immunoregulatory index in the presence of an increase in cytotoxic T cells and the absence of an increase in the number of activated T cells. Differences in humoral component of the immune response in patients with AKI were manifested in the absence of an increase in B-cells number and IgM level with a significant increase in levels of IgA, CIC and anti-TPO.