What does it mean to have impaired renal function and elevated liver enzymes?

From the Guidelines

Impaired renal function, as indicated by a creatinine level of 1.38, and elevated liver enzymes, such as ALT of 62, suggest that both your kidneys and liver are not working properly, and you should seek immediate medical attention to address the underlying cause and prevent potential complications. When kidneys are impaired, they cannot effectively filter waste products from your blood, potentially leading to the buildup of toxins, fluid retention, and electrolyte imbalances. This can be detected through blood tests showing elevated creatinine and blood urea nitrogen (BUN) levels, or through decreased glomerular filtration rate (GFR) 1. Elevated liver enzymes, particularly ALT, AST, ALP, and GGT, suggest liver cell damage or inflammation, which can be caused by various factors, including medications, infections, or chronic conditions like diabetes or hypertension 1.

Key Considerations

• The severity of impaired renal function and elevated liver enzymes can vary widely, from mild and temporary to severe and life-threatening, depending on the cause and extent of organ dysfunction.
• Treatment typically addresses the underlying cause, which could include stopping harmful medications, managing infections, or controlling chronic conditions like diabetes or hypertension.
• It is essential to monitor liver blood tests, including AST, ALT, and bilirubin, before each infusion and/or consider weekly if grade 1 LFT elevations are present, and to review medications and supplements that may cause hepatotoxicity 1.
• A liver biopsy should be considered if the patient is steroid-refractory or if concern for other differential diagnoses that would alter medical management exists.

Recommendations

• Seek immediate medical attention to address the underlying cause of impaired renal function and elevated liver enzymes.
• Workup and evaluation should include monitoring liver blood tests, reviewing medications and supplements, and considering liver biopsy if necessary.
• Treatment should address the underlying cause, and adjustments to medication dosages may be necessary, especially for drugs processed by the liver or excreted by the kidneys.

From the FDA Drug Label

Abnormalities in liver enzymes have not been associated with Ursodiol therapy and, in fact, Ursodiol has been shown to decrease liver enzyme levels in liver disease. Patients given Ursodiol should have SGOT (AST) and SGPT (ALT) measured at the initiation of therapy and thereafter as indicated by the particular clinical circumstances

Les résultats des tests de fonction hépatique (ALT 62) et de la créatinine (1,38) indiquent une altération de la fonction rénale et une élévation des enzymes hépatiques. Cependant, selon le libellé du médicament Ursodiol 2, les anomalies des enzymes hépatiques ne sont pas associées au traitement par Ursodiol. Il est donc difficile de tirer une conclusion directe sur la signification de ces résultats sans plus d'informations sur le contexte clinique. Les examens de suivi sont nécessaires pour évaluer l'évolution de ces paramètres et déterminer la meilleure ligne de conduite.

From the Research

Impaired Renal Function

• Elevated creatinine levels, such as 1.38, can indicate impaired renal function, but it is essential to consider other factors that may influence creatinine levels, such as dietary intake 3.
• A systematic approach to finding the underlying cause of an elevated creatinine level is necessary, including history, physical examination, and baseline tests to identify the cause of renal failure 4.

Elevated Liver Enzymes

• Elevated alanine aminotransferase (ALT) levels, such as 62, can indicate liver damage or disease, and updated upper reference limits (URLs) for ALT levels have been defined to better predict liver disease 5.
• The URLs for ALT levels are 42 U/L for males and 30 U/L for females, and these updated limits can detect steatosis and significant fibrosis in individuals with dysmetabolism 5.

Relationship between Renal Function and Liver Enzymes

• There is no direct relationship between impaired renal function and elevated liver enzymes, but both conditions can be related to underlying diseases or conditions, such as hypertension or diabetes 6.
• It is essential to consider the overall clinical picture and perform further tests to determine the underlying cause of both impaired renal function and elevated liver enzymes 4, 5.