A Determination of the Serum Ascitic Fluid Albumin Concentration Gradient in Children with Chronic Liver Disease and Nephrotic Syndrome

This prospective cross sectional study was carried out in the Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital and Dhaka Shishu Hospital, Dhaka for a period of one year and six months starting from July 2012 to December 2013. The main objective of the study was to determine the serum ascitic fluid albumin concentration gradient in children with chronic liver disease and nephrotic syndrome. A total of 55 children were studied. Among them, 31 children with chronic liver disease with ascites were designated as Group I and rest 24 nephrotic syndrome children with ascites were designated as group II. The mean age of the children was 8.3±3.6 years ranging from 1.0-15.0 years. The mean age of the male patient was 8.0±3.6 years and that of female patients was 9.3±3.5 years. No statistically significant mean age difference was found between male and female patients (p>0.05), although female patients had a bit higher mean age than male patients. The mean age of the group I patients was 9.2±3.7 years ranging from 1.0-14.0 years and group II patients was 7.2±3.2 ranging from 2.0 to 15.0 years and the mean age difference between two groups patients was statistically significant (p<0.05) indicated that patients with chronic liver disease had higher age than patients with nephrotic syndrome. Chronic liver diseases patients where liver biopsy could not be performed to ascertain the exact nature of the disease were labeled as unclassified chronic liver disease. The aetiology of chronic liver diseases of the group I patients. Out of 31 patients, highest percentage of patients were of unknown etiology 17 (54.9%) followed by hepatitis B virus 7 (22.6%) and Wilson’s disease 5 (16.1%). It was evident that 24 (77.4%) had serum bilirubin >1.2 mg/dl, serum ALT >40 IU/L was 25 (80.6%), prothrombin time more than 3 second than control 23 (74.2%) and serum albumin less than 3.5 mg/dl was 24 (77.4%). The mean serum albumin was 2.8±0.5 mg/dl in group I patients and 1.7±0.4 mg/dl in group II patients. The albumin in ascitic fluid was 1.2±0.4 mg/dl in group I patients and 0.9±0.3 mg/dl in group II patients. Similarly, serum-ascites albumin gradient was 1.6±0.5 in group I and 0.8±0.2 in group II. It was evident that mean serum albumin, ascetic albumin as well as serum-ascites albumin gradient was significantly higher among the group I patients compared to group II patients (p<0.001).