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Renal and hepatobiliary dysfunction in chronic obstructive pulmonary disease

Mapel, Douglas

Current Opinion in Pulmonary Medicine: March 2014 - Volume 20 - Issue 2 - p 186–193
doi: 10.1097/MCP.0000000000000024
OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Basil Varkey

Purpose of review: This review examines the associations between chronic obstructive pulmonary disease (COPD) and renal and hepatobiliary diseases, with emphasis on the epidemiology and clinical outcomes, along with current information on pathophysiologic mechanisms and risk factors.

Recent findings: Glomerular filtration, sodium retention, and waste excretion are abnormal in COPD and sensitive to hypoxemia and hypercarbia, but variably responsive to oxygen administration and angiotensin-converting enzyme inhibition. Newer concepts about the role of hypoxia on the progression of chronic renal failure, and improved understanding about the relationships between COPD, decreased arterial compliance, and renal glomerular injury, are bringing new insights about potential causal mechanisms between COPD and kidney diseases. Other than the well known relationship between cor pulmonale and passive liver congestion, little was known about the relationships between COPD and liver diseases until recent population-based surveys demonstrated that COPD patients have substantially elevated risk for specific hepatobiliary system diseases.

Summary: Renal complications of COPD are common especially among patients with hypoxemia and hypercarbia. Renal-endocrine mechanisms, tissue hypoxia, and vascular rigidity have roles in the pathophysiology, but understanding of causal relationships is not precise. COPD patients have increased risk for hepatobiliary diseases and asymptomatic elevations of hepatic transaminases, which fortunately have relatively low prevalence.

Lovelace Clinic Foundation, Health Services Research Division, Albuquerque, New Mexico, USA

Correspondence to Douglas Mapel, MD, MPH, FCCP, Medical Director, Lovelace Clinic Foundation, Health Services Research Division, 2309 Renard Place SE, Suite 103, Albuquerque, NM 87106-4264, USA. Tel: +1 505 938 9900; e-mail: DMapel@comcast.net

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins