Ascites and hyponatremia are the most common complications in patients with liver cirrhosis and develop as a consequence of a severe impairment of liver function and portal hypertension. Increasing evidences support t...Ascites and hyponatremia are the most common complications in patients with liver cirrhosis and develop as a consequence of a severe impairment of liver function and portal hypertension. Increasing evidences support the central role of renal function alterations in the pathogenesis of hydroelectrolytic imbalances in cirrhotic patients, thus implying a dense cross-talk between liver and kidney in the systemic and splanchnic vascular homeostasis in such subjects. Since Arginin Vasopressin(AVP) hyperincretion occurs at late stage of cirrhosis and plays an important role in the development of refractory ascites, dilutional hyponatremia and finally hepato-renal syndrome, selective antagonists of AVP receptors V2(vaptans) have been recently introduced in the therapeutic algorithm of advanced cirrhotic patients. Despite the promising results of earlier phasetwo studies, randomized controlled trials failed to find significant results in terms of efficacy of such drugs both in refractory ascites and hyponatremia. Moreover, concerns on their safety profile arise, due to the number of potentially severe side effects of vaptans in the clinical setting, such as hypernatremia, dehydration, renal impairment, and osmotic demyelination syndrome. More robust data from randomized controlled trials are needed in order to confirm the potential role of vaptans in the management of advanced cirrhotic patients.展开更多
Cryoglobulinemia is a pathological condition usually associated with hepatitis C virus(HCV) chronic liver disease and less commonly with autoimmune or lymphoproliferative disorders.The possible association of cryoglob...Cryoglobulinemia is a pathological condition usually associated with hepatitis C virus(HCV) chronic liver disease and less commonly with autoimmune or lymphoproliferative disorders.The possible association of cryoglobulinemia with hepatitis B virus(HBV) infection is not widely accepted.In our patient,serum negativity for HCV markers initially led us to consider two other causes of cryoglobulinemia.Myelodysplastic disorders were excluded on the basis of hematological studies,while serum markers for active HBV infection were positive.Surprisingly,the detection of HCV RNA in the cryocrit,even in the absence of anti-HCV antibodies suggested a pathogenetic role of HCV in this case of cryoglobulinemia.Negative "first level" tests for HCV in the serum do not completely exclude HCV involvement in the pathogenesis of cryoglobulinemia.Analysis of the cryoprecipitate is always essential for diagnosis.展开更多
文摘Ascites and hyponatremia are the most common complications in patients with liver cirrhosis and develop as a consequence of a severe impairment of liver function and portal hypertension. Increasing evidences support the central role of renal function alterations in the pathogenesis of hydroelectrolytic imbalances in cirrhotic patients, thus implying a dense cross-talk between liver and kidney in the systemic and splanchnic vascular homeostasis in such subjects. Since Arginin Vasopressin(AVP) hyperincretion occurs at late stage of cirrhosis and plays an important role in the development of refractory ascites, dilutional hyponatremia and finally hepato-renal syndrome, selective antagonists of AVP receptors V2(vaptans) have been recently introduced in the therapeutic algorithm of advanced cirrhotic patients. Despite the promising results of earlier phasetwo studies, randomized controlled trials failed to find significant results in terms of efficacy of such drugs both in refractory ascites and hyponatremia. Moreover, concerns on their safety profile arise, due to the number of potentially severe side effects of vaptans in the clinical setting, such as hypernatremia, dehydration, renal impairment, and osmotic demyelination syndrome. More robust data from randomized controlled trials are needed in order to confirm the potential role of vaptans in the management of advanced cirrhotic patients.
文摘Cryoglobulinemia is a pathological condition usually associated with hepatitis C virus(HCV) chronic liver disease and less commonly with autoimmune or lymphoproliferative disorders.The possible association of cryoglobulinemia with hepatitis B virus(HBV) infection is not widely accepted.In our patient,serum negativity for HCV markers initially led us to consider two other causes of cryoglobulinemia.Myelodysplastic disorders were excluded on the basis of hematological studies,while serum markers for active HBV infection were positive.Surprisingly,the detection of HCV RNA in the cryocrit,even in the absence of anti-HCV antibodies suggested a pathogenetic role of HCV in this case of cryoglobulinemia.Negative "first level" tests for HCV in the serum do not completely exclude HCV involvement in the pathogenesis of cryoglobulinemia.Analysis of the cryoprecipitate is always essential for diagnosis.
