Abstract
INTRODUCTION: Patients with non-alcoholic fatty liver disease (NAFLD) have higher prevalence of nephrolithiasis. The aim of the present study was to determine prevalence of hepatic steatosis on ultrasonography in nephrolithiasis patients. METHODS: Charts of 318 consecutive nephrolithiasis patients seen in stone clinic between January and February 2018 were retrospectively reviewed. Ultrasound reports were reviewed for hepatic steatosis. Subsequent liver investigations were noted. Patients' demographic predictors of hepatic steatosis were identified using univariable logistic regression models. RESULTS: A total of 162 patients was included, of which 76 (46.9%) were found to have hepatic steatosis and 22 (13.6%) were found to have moderate-to-severe hepatic steatosis. Median followup was 2.03 years. Predictors of hepatic steatosis included higher body mass index and smoking (both p<0.05). Progression of fatty liver on ultrasound was noted for 13 (17.1%) and regression was noted for two (2.6%). Of the 16 patients with a Fibrosis-4 (FIB-4) score, four (25.0%) patients required further investigation and 12 (75.0%) were unlikely to have advanced fibrosis. Of 12 patients who underwent fibroscan, one (8.3%) had both fibrosis and cirrhosis, two (16.7%) fibrosis only, and two (16.7%) moderate-to-severe steatosis. CONCLUSIONS: Hepatic steatosis on ultrasound followup of nephrolithiasis patients is common, especially in smokers and overweight patients. Current recommendations suggest that primary care physicians calculate a FIB-4 score upon the detection of hepatic steatosis on ultrasound. The decision to refer to hepatology for a corroborative fibroscan is then based on the FIB-4 score.