Assessment of Urinary Albumin/Creatinine Ratio in Non-Obese Non-Diabetic Patients with Nonalcoholic Fatty Liver Disease

Abstract

Nonalcoholic fatty liver disease (NAFLD) is a pathological condition seen as histological change ranging from simple steatosis to steatohepatitis, advanced fibrosis and liver disease among patients without significant alcohol consumption. Microalbuminuria which is defined as the urinary albumin excretion of 30 - 300 mg/24h has been reported to be a risk factor for renal and cardiovascular disorders. It also has independent correlation to high mortality in diabetic and hypertensive patients. NAFLD is affecting non obese non diabetic individuals; Microalbuminuria is correlated to visceral adipose tissue even in non diabetic non obese patients with limited studies in this aspect. Microalbuminuria is considered as a risk factor for cardiovascular and chronic kidney disease. Aim of the work: To assess urinary albumin creatinine ratio in non-obese non-diabetic patients with nonalcoholic fatty liver disease. Patients and methods: Total number of 80 patients with NAFLD that were non diabetic non obese patients. Abdominal ultrasonography and laboratory investigations were done. Results: Eighty non-obese, non-diabetic subjects (32 women, 48 men) with the mean age of 50.9 were included in this study. The population of the study was classified into four groups according to ultrasonographic degrees of steatosis. Control Group (A), (No. 25) 31.25% of total cases are reported as no fat accumulation in liver. Group B; No. 21 26.25% of total cases are reported as had mild steatosis (NAFLD 1). Group C; No. 18 (22.5%) of total cases and reported as had moderate fat accumulation (moderate steatosis). Group D; No. 16 (20%) of total cases reported had severe fat accumulation (severe steatosis). Urinary albumin creatinine ratio also shows increase in its values with increasing in the degree of steatosis among different groups which is highly statistically significant. Triglycerides, total cholesterol and LDL show also significant changes between groups as they are significantly increased in value as regard increasing in degree of steatosis, inversely noticed with HDL levels as it goes down with elevated degree of steatosis which is statistically significant. Discussion: The effects of fatty liver disease on renal functions have been evaluated in some studies; in this study we tried to evaluate the correlation between microalbuminuria and various degrees of steatosis in non-obese non diabetic patients; we found that NAFLD could be seen in non obese non diabetic individuals with special reference to other factors that may influence the progress of the disease such as hyperlipidemia with increased risk of microalbuminuria among those patients. Conclusion: After exclusion of type 2 DM and obesity, we conclude that the presence and the severity of microalbuminuria are more apparent among NAFLD patients.