The Difference of Urinary Neutrophil Gelatinase-Associated Lipocalin Level between Liver Cirrhosis Patients with and without Hepatorenal Syndrome

Objective: To determine differences of urinary Neutrophil Gelatinase-Associated Lipocalin level in liver cirrhosis patients with or without Hepatorenal Syndrome (HRS). Methods: This study was conducted on 46 liver cirrhosis patients (20 patients without hepatorenal syndrome, 26 patients with hepatorenal syndrome). Diagnosis of HRS was based on International Ascites Club criteria. Urinary NGAL was examined using ELISA method. Data analysis was performed with p<0,05 stated as statistically significant. Result: This study showed more HRS cases was found in male than female, with an average age of 53,95 years old for hepatic cirrhosis without HRS, and 57,35 with HRS. The most common cause of this study is Hepatitis B virus, and the highest grade of severity is in Child Pugh-C. The average urinary NGAL level in liver cirrhosis with HRS is 59,39 ± 58,98 ng/ml and 130,78 ± 45,14 ng/ml in liver cirrhosis without HRS. Conclusion: There was a significant higher urinary NGAL level in liver cirrhosis with HRS (p = 0.000), with the cut-off of urinary NGAL to differentiate cirrhosis patients with and without HRS was 95,115 ng/ml. Keywords: NGAL, HRS, hepatorenal syndrome, neutrophil gelatinase-associated lipocalin.

Advances in the diagnosis and therapy of liver cirrhosis: a systematic review / Avanços no diagnóstico e terapia da cirrose hepática: uma revisão sistemática

Hepatic cirrhosis (HC) is a diffuse pathophysiological state of the liver considered to be the end-stage of several liver injuries. It is essential to highlight the need to implement new diagnostic and treatment methods to contain subsequent damage to liver cirrhosis, so that we can better understand the pathophysiological process of the disease and obtain better therapeutic results. Thus, this study aimed to identify advances in diagnostic methods and treatments for liver cirrhosis. This is a systematic literature review study, conducted by searching the descriptors “Liver cirrhosis”, “Alcoholic liver cirrhosis”, “Liver fibrosis” and “Liver”, in the databases: Scielo- Scientific Electronic Library Online, Lilacs - Latin American and Caribbean Center on Health Sciences Information, NIH-NCBI-Pubmed- National Center for Biotechnological Information – National Library of Medicine, following a search strategy according to descriptors in Portuguese and English, years 2015 to 2021. At the end of the search with the descriptors, 835 articles were found in the databases, of which 88 were in the Scielo platform, 286 in Lilacs and 461 in Pubmed. After the three selection steps, 811 articles were excluded and 23 articles that met the inclusion and exclusion criteria were selected for analysis. Based on this systematic review, it is pointed out that there has been a lot of development regarding the diagnosis and treatment of cirrhosis that, for many years, required scientific evidence to combat morbidity and mortality and reverse the condition of liver cirrhosis.

Hepatorenal Polycystosis Complicated By Hepatic Cirrhosis: A Case Report

Polycystic liver disease is most commonly associated with autosomal dominant polycystic kidney disease. Hepatic cysts are the most common extrarenal manifestation of autosomal dominant polycystic kidney disease. The progression to cirrhosis remains rare, and the data is sparse, the only curative treatment is liver transplantation. We report the case of a young patient with hepato-renal polycystosis at the stage of cirrhosis.

Peptidylglycine α-Amidating Monooxygenase And Adrenomedullin Measurement In Cirrhosis Suggesting Cardiomyopathy

Peptidylglycine α-amidating monooxygenase (PAM) is a processing enzyme involved in maturation of regulatory peptides. One product of PAM activity is adrenomedullin (bio-ADM), which regulates vascular tone and endothelial integrity. In this study, we examined PAM activity and bio-ADM concentrations in patients with various degrees of hepatic cirrhosis including the role of the liver in net release of the two markers. We enrolled 48 patients with cirrhosis and 16 control subjects: The patients were evenly distributed according to the Child-Turcotte classification. PAM activity was progressively increased in cirrhotic patients but without a net release across the liver, leg, or kidney. In contrast, bio-ADM concentrations were not only associated to severity of disease but also found to be directly released by the liver. Given the major expression of PAM in the heart, we propose that increased PAM activity in plasma from patients with cirrhosis may reflect cardiac involvement, e.g. cirrhotic cardiomyopathy.

A new p65 isoform that bind the glucocorticoid hormone and is expressed in inflammation liver diseases and COVID-19

Inflammation is a physiological process whose deregulation causes some diseases including cancer. Nuclear Factor kB (NF-kB) is a family of ubiquitous and inducible transcription factors, in which the p65/p50 heterodimer is the most abundant complex, that play critical roles mainly in inflammation. Glucocorticoid Receptor (GR) is a ligand-activated transcription factor and acts as an anti-inflammatory agent and immunosuppressant. Thus, NF-kB and GR are physiological antagonists in the inflammation process. Here we show that in mice and humans there is a spliced variant of p65, named p65 iso5, which binds the corticosteroid hormone dexamethasone amplifying the effect of the glucocorticoid receptor and is expressed in the liver of patients with hepatic cirrhosis and hepatocellular carcinoma (HCC). Furthermore, we have quantified the gene expression level of p65 and p65 iso5 in the PBMC of patients affected by SARS-CoV-2 disease. The results showed that in these patients the p65 and p65 iso5 mRNA levels are higher than in healthy subjects. The ability of p65 iso5 to bind dexamethasone and the regulation of the glucocorticoid (GC) response in the opposite way of the wild type improves our knowledge and understanding of the anti-inflammatory response and identifies it as a new therapeutic target to control inflammation and related diseases.

Coronary revascularization in a patient with cirrhosis and renal failure. Coronary artery bypass grafting in a patient with hepatic cirrhosis and end stage renal disease

Surgery in a patient with hepatic cirrhosis entails risk of complications and of death. Association of end stage renal disease (ESRD) along with cirrhosis further increases perioperative risk of morbidity and mortality. There are no reports in the literature of patients with liver cirrhosis and ESRD having undergone cardiac surgery. We present a report of a successfully operated case of ESRD with compensated hepatic cirrhosis posted for coronary artery bypass grafting.

Patient- oriented approach to management of patients with hepatic cirrhosis

Aim of the study: Optimization of medical care to patients with liver cirrhosis (LC) based on using of patient- oriented approach in real clinic practiceMaterials and methods: The reviews of 734 medical histories of patients treated in polyclinics and in-patient facilities of general specialization (surgery, therapy) and died from HL in 2015–2019 years in Krasnodar region were analyzed. The experience of regular medical check-up of 85 patients with LC who underwent mini-invasive surgeries was summarized.Results: The number of mistakes in treatment tactics of patients with LC was revealed. The experience of regular medical check-up and schools for patients with LC was summarized.Conclusion: Regular medical check-up of patients with LC in multi- disciplinary clinic with practice in mini-invasive surgeries and liver transplantation, attendance of schools for patients improves stabilization and in some cases treatment course of disease.

A comparison of clinical pathologic characteristics between alpha-fetoprotein negative and positive liver cancer patients from Eastern and Southern China

Background Alpha-fetoprotein (AFP) is a biomarker used in clinical management of hepatocellular carcinoma (HCC), however, approximately 40% of HCC patients do not present with elevated serum AFP levels. This study aimed to investigate the clinical and pathologic characteristics between AFP positive and negative primary liver cancer (PLC) patients to allow for improved clinical management and prognostication of the disease. Methods This study observed a cohort of PLC patients from Eastern and Southern China with comparisons of the clinical and pathologic features between serum AFP positive and negative patient groups; patients with decompensated hepatic cirrhosis, those with chronic hepatitis B, and hepatitis B virus (HBV) asymptomatic carrier patients were used as controls. Data included the laboratory results, pathology diagnosis, clinical staging and scores were obtained from routine clinical diagnostic methods. Results Patients with HCC, larger tumor sizes, liver cancer with hepatic cirrhosis, portal vein thrombosis, metastasis, high Child-Pugh score, high Barcelona-Clínic Liver Cancer (BCLC) stage, and advanced clinical stage had significantly higher serum AFP levels. Also, patients with HBsAg and HBeAg positive, high HBV DNA levels had significantly higher serum AFP levels. Patients with high serum AFP levels had higher protein induced by vitamin K absence or antagonist-II (PIVKA-II), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alpha-l-fucosidase (AFU), gamma-glutamyl transpeptidase (γ-GT), γ-GT /ALT, direct bilirubin (DBIL), indirect bilirubin (IDBIL), fibrinogen, and D-dimer levels. Serum AFP status was inversely associated with serum carcinoembryonic antigen (CEA). Patients with AFP positive had higher white blood cells (WBC), neutrophil, monocyte, and platelet count and neutrophil to lymphocyte ratio (NLR). Conclusions The are significant differences in clinical pathologic characteristics between AFP positive and negative PLC patients which may be helpful for the management and prognostication of the disease.