Journal of Renal and Hepatic Disorders
type: channel
description: Journal of Renal and Hepatic Disorders (eISSN: 2207-3744) is a peer-reviewed, online-only, open-access journal that publishes basic science and clinical research articles on disorders of the kidneys and the liver. In addition to considering disorders of each organ separately, the journal aims to be a scholarly forum for discussing how disorders of one organ influence the other. Chronic liver disease is associated with primary and secondary kidney diseases. Similarly, renal disorders are associated with hepatic disorders. Original articles, reviews, and case reports on any aspects of nephrology and hepatology are suitable for submission.
publisher: Troika Publisher
language: en
publication name: Journal of Renal and Hepatic Disorders
issn: 2207-3744
copyright: Authors who publish with this journal agree to the following terms: Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access
items: A Neglected Case of Wilson’s Disease Presenting as Symptomatic Urolithiasis and Proteinuria: A Case Report and Review of the Literature
items: Orthotopic Liver Transplantation in a Case of Novel YAP1-TFE3 Hepatic Epithelioid Hemangioendothelioma [HEHE]; Case Report and Review of Literature
items: Sewing Needle as Foreign Body in Urethra of an Adolescent Boy: Case Report
items: Hepatic Vein and Inferior Vena Cava Reconstruction during Hepatic Surgery Resection for Cancer
items: Body Composition of Chronic Kidney Disease Patients: A Multi-Stage Analysis
items: Metabolic Syndrome in Adults with Nonalcoholic Fatty Liver Disease
items: A Case Presentation of Gastrointestinal Stromal Tumor of Duodenum
items: Ex vivo Resection for Renal Cancer: Indications and Results in Specific Clinical Scenarios
items: The Role of the Liver in Iron Homeostasis and What Goes Wrong?
items: Echocardiographic Changes in Patients with End-Stage Renal Disease at Initiation of Dialysis
items: The Comparison of Outcome in Treating Proximal Ureteric Stones of Size 10 mm to 15 mm Using Extracorporeal Shock Wave Lithotripsy as Compared to Ureterorenoscopic Manipulation Using Holmium Laser
items: Paradigm Shift in Etiology of Upper Gastrointestinal Bleed in Emergency Department
items: Acute Alcohol Tissue Damage: Protective Properties of Betaine
items: The Indirect Implication of SARS-CoV-2 Resulting in Kayexalate Toxicity in a Patient with Acute Kidney Injury
items: Comparison of Transient Elastography and Liver Biopsy in Assessing Fibrosis in Patients with Nonalcoholic Fatty Liver Disease
items: Histological Evaluation of Extended Criteria Donors: Donor’s Kidney Biopsy and Graft Outcome after 5 Years of Transplantation
items: HBV Hepatitis and Related Renal Nephropathies: Pathogenesis and Treatment
items: Hepatocellular Carcinoma: A Review
items: Yersinia enterocolitica Infection in Patients Undergoing Intermittent Hemodialysis
items: Direct-Acting-Antivirals Anti-hepatitis C Virus in Renal Transplant Patients: Relevance of Pharmacologic Interaction
items: Study of Urinary Alpha Glutathione-S-Transferase in Children with Idiopathic Nephrotic Syndrome
items: Acute Kidney Injury and Acute Liver Failure in Leptospira Infection and Weil’s Syndrome
items: Manganese-Induced Nephrotoxicity Is Mediated through Oxidative Stress and Mitochondrial Impairment
items: The Novel Coronavirus 2019 Epidemic and the Kidneys
items: An Update on Hepatorenal Syndrome
items: Plasmapheresis in the Management of Acute Pancreatitis due to Severe Hypertriglyceridemia—Reporting New Cases
items: Reprogrammed Cell‐based Therapy for Liver Disease: From Labto Clinic
items: Renal Concerns in the Treatment of Chronic Hepatitis B with Tenofovir
items: Novel Therapeutic Strategies Targeting Molecular Pathways of Cystogenesis in Autosomal Polycystic Kidney Disease
items: Anaemia of Chronic Kidney Disease: What We Know Now

A Neglected Case of Wilson’s Disease Presenting as Symptomatic Urolithiasis and Proteinuria: A Case Report and Review of the Literature
type: item
description: We report a short-statured, 39-year-old male presenting with recurrent kidney stones, history of refractory rickets, and bone deformity. He had been consuming multiple doses of calcium supplements and multiple courses of vitamin D over past 30 years before prior to reporting in our clinic without any significant laboratory or clinical improvement. The patient was diagnosed as having Fanconi’s syndrome attributable to Wilson’s disease. This patient highlighted that in case of resistant rickets, a high index of uncertainty must be invoked for Wilson’s disease. Appropriate timely recognition of this entity results in prompt ministrations and prevention of disability. We also presented and discussed reviews on Wilson’s disease from literature.
subject: Case Reports Nephrology
  topic: section
subject: bone disease
  topic: keywords
subject: renal tubular acidosis
  topic: keywords
subject: Wilson’s disease
  topic: keywords
creator: Elham Zare
creator: Zahra Mahbubi
creator: Maryam Panahi
rights: Copyright (c) 2021 Elham Zare, Zahra Mahbubi, Maryam Panahi http://creativecommons.org/licenses/by/4.0
date: 2021-10-07
publication date: 2021-10-07
starting page: 39
ending page: 44
doi: 10.15586/jrenhep.v5i2.123

Orthotopic Liver Transplantation in a Case of Novel YAP1-TFE3 Hepatic Epithelioid Hemangioendothelioma [HEHE]; Case Report and Review of Literature
type: item
description: Epithelioid hemangioendothelioma is an extremely rare vascular neoplasm arising in soft-tissues and different visceral organs, with liver being the most commonly involved viscera. Hepatic epithelioid hemangioendothelioma (HEHE) is a malignant tumour with an indolent behaviour and unpredictable clinical course. It has a better prognosis among the malignant tumours of the liver, in spite of being a diffuse multifocal liver disease or metastatic at the time of presentation. HEHE is usually found to be noted in the fifth decade with slight female preponderance. No single treatment strategy has yet been established owing to its variable clinical course, ranging from an indolent tumour with prolonged survival to an aggressive, metastatic disease with a fatal outcome. Here, we present a case of a novel HEHE in a 25-year-old female who was treated successfully with orthotopic living donor liver transplantation and discuss the presentation, histopathology and management of this rare, fatal yet treatable malignant tumour.
subject: Case Reports Hepatology
  topic: section
subject: hepatic epitheloid hemangioendothelioma
  topic: keywords
subject: vascular tumour
  topic: keywords
creator: Sugi SRV
creator: Elankumaran Krishnan
creator: Kulaseharan Venugopal Haribabu
creator: Hari Balakrishnan
creator: Shantha Ravisankar
rights: Copyright (c) 2021 Sugi SRV, Elankumaran Krishnan, Kulaseharan Venugopal Haribabu, Hari Balakrishnan, Shantha Ravishankar http://creativecommons.org/licenses/by/4.0
date: 2021-10-14
publication date: 2021-10-14
starting page: 45
ending page: 49
doi: 10.15586/jrenhep.v5i2.122

Sewing Needle as Foreign Body in Urethra of an Adolescent Boy: Case Report
type: item
description: Self-insertion of a foreign body in the urethra is an uncommon presentation clinically. The cases usually arise due to fulfillment of sexual desire, for recreation, play, or exploration, or the foreign body insertion may take place accidentally. We present a case of an adolescent boy with a foreign body urethra presenting to the emergency room with urinary retention, pain, and dysuria. Attending urologist suspected urethral stricture and ordered ultrasonography to investigate which turned out to be a sewing needle in his urethra. The patient was then enquired about the foreign body. He tried to self-dilate his urethra as he was experiencing lower urinary tract symptoms. The sewing needle was removed by endoscopy and he was administered with antibiotics and painkillers. The urethral foreign bodies may present with pain, dysuria, or urinary incontinence and these foreign bodies are mostly seen in the male population in the adolescent age group.
subject: Case Reports Nephrology
  topic: section
subject: endoscopy
  topic: keywords
subject: foreign body
  topic: keywords
subject: removal
  topic: keywords
subject: urethra
  topic: keywords
creator: Kashif Bangash
creator: Muhammad Naeem
creator: Hassan Mumtaz
creator: Aaliah Akhtar Hayat
creator: Mubashar Mazhar
creator: Shahzaib Ahmad
rights: Copyright (c) 2021 Kashif Bangash, Muhammad Naeem, Hassan Mumtaz, Aaliah Akhtar Hayat, Mubashar Mazhar, Shahzaib Ahmad http://creativecommons.org/licenses/by/4.0
date: 2021-09-08
publication date: 2021-09-08
starting page: 17
ending page: 19
doi: 10.15586/jrenhep.v5i2.119

Hepatic Vein and Inferior Vena Cava Reconstruction during Hepatic Surgery Resection for Cancer
type: item
description: Invasion of tumor in the liver requires surgical interventions that may reduce the effects or may eliminate the tumor-affected cells. The renewal of the hepatic vein and inferior vena cava has enabled most specialized oncologists and medical specialists to use advanced diagnostic methods in the treatment of the liver tumors. Liver resection has prolonged the lives of many patients and the invention of live donor organ transplants has effectively enabled the use of liver resection in most cancer centers across the world. By reviewing data from 10 articles, 21 surgical analyses were investigated and analyzed for the risks involved in the applications of reconstructions of hepatic vein and inferior vena cava in the surgical liver resection. The postoperative complications and the indications of reconstructions were mentioned. The results indicated that with these surgical procedures, complications are still involved but may be successful for particular patients.
subject: Review Hepatology
  topic: section
subject: cancer/tumor
  topic: keywords
subject: hepatic surgery
  topic: keywords
subject: hepatic vein
  topic: keywords
subject: inferior vena cava
  topic: keywords
subject: liver resection
  topic: keywords
subject: reconstruction
  topic: keywords
creator: Danilo Coco
creator: Silvana Leanza
rights: Copyright (c) 2021 Danilo Coco, Silvana Leanza http://creativecommons.org/licenses/by/4.0
date: 2021-09-09
publication date: 2021-09-09
starting page: 14
ending page: 16
doi: 10.15586/jrenhep.v5i2.113

Body Composition of Chronic Kidney Disease Patients: A Multi-Stage Analysis
type: item
description: With accelerated muscle proteolysis, a decrease in muscle mass is evident in chronic kidney disease (CKD) patients. This eventually leads to nutritional disturbance that for a long has been mostly attributed to malnutrition. This predisposes patients to premature morbidity and mortality. Assessing body composition, thus, becomes vital. In this cross-sectional study, CKD patients (n = 47) of stages 2, 3a, 3b and 4 were assessed for their lean tissue mass, adipose tissue mass and overhydration by body composition monitor. Lean tissue index and fat tissue index were calculated as lean tissue mass and adipose tissue mass in kilogram divided by patients’ height in square meters. Patients were assessed for their handgrip strength (HGS) by Jamar hydraulic hand dynamometer, and also for their 7-day diet history. Mean lean tissue index of CKD patients was 11.73 ± 2.49 kg/m2. About 34 (72.3%) out of 47 patients were below the reference value of lean tissue index. A significant difference in lean tissue index (P = 0.03) was observed at various stages. Patients at stage 4 had the lowest lean tissue index. Lean tissue was significantly (P = 0.03) low in patients consuming protein <0.6 gm/kg/day. All 47 patients had less than normal HGS values. Patients’ mean fat tissue index was 14.86 ± 6.18 kg/m2 and had water retention with a mean overhydration of 1.47 ± 2.12 L. CKD patients were malnourished with a significant low lean tissue index. Dietary protein intake and HGS of these patients were positively associated with lean tissue index.
subject: Original Articles Nephrology
  topic: section
subject: body composition
  topic: keywords
subject: chronic kidney disease
  topic: keywords
subject: lean tissue index
  topic: keywords
subject: malnutrition
  topic: keywords
subject: muscle strength
  topic: keywords
creator: Anjani Bakshi
creator: Kalyani Singh
creator: Anupa Siddhu
rights: Copyright (c) 2021 Anjani Bakshi, Kalyani Singh, Anupa Siddhu http://creativecommons.org/licenses/by/4.0
date: 2021-06-30
publication date: 2021-06-30
starting page: 54
ending page: 58
doi: 10.15586/jrenhep.v5i1.102

Metabolic Syndrome in Adults with Nonalcoholic Fatty Liver Disease
type: item
description: Nonalcoholic fatty liver disease (NAFLD) is associated with insulin resistance, obesity, and other features of metabolic syndrome. It is identified as the most common cause of liver enzyme derangement. Lately, NAFLD has generated interest in exploring treatment options, including weight loss and dietary interventions. An association of NAFLD with metabolic syndrome has been suggested in contemporary literature. In this study, we attempted to look into the association of NAFLD with metabolic syndrome. In this study, 80 adult NAFLD patients were recruited from a tertiary care hospital. Among these, 42 were males and 38 females with a mean age of 44.46±13.146 years (range 18–82 years). Grades of fatty liver and presence or absence of metabolic syndrome were studied in this patient population. Patients who did not qualify for the criteria of metabolic syndrome were placed in Group 1 and those who fulfilled the stated criteria were considered in Group 2. There were 29 (36.25%) patients in Group 1 and 51 (63.75%) in Group 2. All the patients in Group 1 were having Grade I fatty liver whereas patients in Group 2 were found to having varying grades of fatty liver, with six patients having Grade III fatty liver. We found statistically significant difference in various parameters of study (liver enzymes, high-density lipoprotein (HDL), triglycerides, and blood pressure) between Group 1 and Group 2. Ultrasound evidence of a fatty liver should be considered as a predictor of metabolic syndrome, and these patients must be investigated for the different components of metabolic syndrome so as to have early diagnosis and intervention to alter development of long-term metabolic disorders and their inherent complications.
subject: Original Articles Hepatology
  topic: section
subject: fatty liver
  topic: keywords
subject: metabolic syndrome
  topic: keywords
subject: NAFLD
  topic: keywords
creator: Zhahid Hassan
creator: Muzamil Latief
creator: Mahroosa Ramzan
creator: Farhat Abbas
creator: Summyia Farooq
rights: Copyright (c) 2021 Zhahid Hassan, Muzamil Latief, Mahroosa Ramzan, Farhat Abbas, Summyia Farooq http://creativecommons.org/licenses/by/4.0
date: 2026-06-18
publication date: 2026-06-18
starting page: 34
ending page: 37
doi: 10.15586/jrenhep.v5i2.99

A Case Presentation of Gastrointestinal Stromal Tumor of Duodenum
type: item
description: A gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. It is caused by the mutation in KIT and PDGFRα genes. It constitutes <1% of all gastrointestinal tumors. Duodenal GISTs constitute 4.5% of all GISTs. We report a 61-year-old lady, presented with generalized abdominal pain, vomiting, abdominal distension, and nausea for the last 3 years. Physical examination showed a pallor and on abdominal examination, a large palpable mass was extending from the pelvis to the right upper quadrant of the abdomen. The CT scan showed a large heterogeneously echogenic mass in the abdomen and pelvis with no lymphadenopathy and distant metastasis in this region. Laparotomy showed a large globular mass extending from the pelvis to the right upper quadrant of the abdomen adherent to the wall of a third part of the duodenum. Complete surgical resection of tumor done with an intact capsule. Microscopic examination showed neoplastic spindle cells with tumor necrosis. An immunohistochemical study confirmed GIST.
subject: Case Reports Hepatology
  topic: section
subject: cancer intervention
  topic: keywords
subject: duodenum
  topic: keywords
subject: tumor
  topic: keywords
subject: surgery
  topic: keywords
creator: Aamir Ghazanfar
creator: Afifa Asghar
creator: Farrukh Zaman
creator: Hassan Mumtaz
creator: Shahzeb Habib
creator: Shahzaib Ahmad
rights: Copyright (c) 2021 Aamir Ghazanfar, Afifa Asghar, Farrukh Zaman, Hassan Mumtaz, Shahzeb Habib, Shahzaib Ahmad http://creativecommons.org/licenses/by/4.0
date: 2021-06-28
publication date: 2021-06-28
starting page: 49
ending page: 53
doi: 10.15586/jrenhep.v5i1.112

Ex vivo Resection for Renal Cancer: Indications and Results in Specific Clinical Scenarios
type: item
description: To retrospectively evaluate databases for indications and results of “bench surgery technique” in ex vivo or ex situ renal cancer resection as a lost alternative of savage renal function in renal malignancy or benign large tumors. We retrospectively evaluated PUBMED databases, including studies from 1980 to 2020. Only very few studies had analyzed “ex vivo [and] ex situ renal resection, extracorporeal renal resection, [and] renal autotransplantation.” Ex vivo renal resection and autotransplantation is the last chance in patients with renal cancer, but manifests numerous difficulties during and after the surgery. However, we noted that in some patients it provided good control over cancer, prevented long-term dialysis, and avoided renal transplantation, thus giving patients a good quality of life.
subject: Review Nephrology
  topic: section
subject: ex situ liver resection
  topic: keywords
subject: extracorporeal liver resection
  topic: keywords
subject: liver autotransplantation
  topic: keywords
creator: Danilo Coco
creator: Silvana Leanza
rights: Copyright (c) 2021 Danilo Coco, Silvana Leanza http://creativecommons.org/licenses/by/4.0
date: 2021-08-10
publication date: 2021-08-10
starting page: 6
ending page: 9
doi: 10.15586/jrenhep.v5i2.109

The Role of the Liver in Iron Homeostasis and What Goes Wrong?
type: item
description: Iron is an essential mineral that is vital for growth development, normal cellular function, synthesis of hormones and connective tissue, and most importantly, serves as a component of hemoglobin to carry oxygen to body tissues. The body finely regulates the amount of circulating and stored iron within the body to maintain concentration levels within range for optimal physiologic function. Without iron, the ability for cells to participate in electron transport and energy metabolism decreases. Furthermore, hemoglobin synthesis is altered, which leads to anemia and decreased oxygen delivery to tissue. Problems arise when there is too little or too much iron. This review explores the role of the liver in iron physiology, iron overload and discusses the most common causes of primary and secondary hepatic iron overload.
subject: Review Hepatology
  topic: section
subject: liver
  topic: keywords
subject: iron homeostasis
  topic: keywords
subject: iron overload
  topic: keywords
creator: Ernesto Robalino Gonzaga
creator: Irene Riestra Guiance
creator: Richard Henriquez
creator: Gerri Mortimore
creator: Jan Freeman
rights: Copyright (c) 2021 Ernesto Robalino Gonzaga, Irene Riestra Guiance, Richard Henriquez, Gerri Mortimore, Jan Freeman http://creativecommons.org/licenses/by/4.0
date: 2021-09-18
publication date: 2021-09-18
starting page: 26
ending page: 33
doi: 10.15586/jrenhep.v5i2.110

Echocardiographic Changes in Patients with End-Stage Renal Disease at Initiation of Dialysis
type: item
description: Echocardiography is a simple and established method of evaluating cardiac functions, assessing left ventricle geometry, and systolic and diastolic functions. Patients with chronic kidney disease have a tremendous burden of cardiovascular disease (CVD), and patients with end-stage renal disease (ESRD) are at a greater risk of CVD and deaths. In this study, 245 incident dialysis patients were included, and none of the patient was on erythropoietin. All the patients were aged >18 years. Patients with ESRD, already on maintenance dialysis, were not included in this study. Patient’s data such as demographic details, comorbidities, laboratory values, echocardiographic changes, management, and outcome were recorded. Out of 245 patients, 165 (67.3%) were males and 80 (32.6%) females. The mean age of the patients was 49.7 years. Left ventricular hypertrophy (LVH) was observed in 188 (76.7%), mild left ventricular dysfunction (LVD) in 25.7%, moderate LVD in 23.67%, severe LVD in 8.5%, global hypokinesia in 33.8%, valvular heart disease in 26.5%, regional wall motion abnormality in 4.4%, and pericardial effusion in 1.6% patients. Echocardiographic changes, such as LVD, LVH, and global hypokinesia, were observed in greater number in hypertensive group com-pared to normotensive group (P < 0.05). On regression analysis adjusted for age and gender, we found that hypertension and anemia (<10 g/dL) were associated with LVH. Further, hypertension and anemia (Hb < 10 g/dL) were associated with LVD. Similarly, anemia (Hb < 10 g/dL) was associated with global hypokinesia and valvular heart disease. LVD was associated with death in our study. Echocardiography is a noninvasive diagnostic test which detects early changes in cardiac parameters. All ESRD patients with hyper-tension and anemia at the time of initiation of renal replacement therapy must undergo echocardiography screening
subject: Original Articles Nephrology
  topic: section
subject: echocardiography
  topic: keywords
subject: hypertension
  topic: keywords
subject: CKD
  topic: keywords
creator: Shabana Nazneen
creator: Muzamil Latief
creator: Manjusha Yadla
rights: Copyright (c) 2021 Shabana Nazneen, Muzamil Latief, Manjusha Yadla http://creativecommons.org/licenses/by/4.0
date: 2021-06-09
publication date: 2021-06-09
starting page: 44
ending page: 48
doi: 10.15586/jrenhep.v5i1.98

The Comparison of Outcome in Treating Proximal Ureteric Stones of Size 10 mm to 15 mm Using Extracorporeal Shock Wave Lithotripsy as Compared to Ureterorenoscopic Manipulation Using Holmium Laser
type: item
description: Urinary stone disease or nephrolithiasis, the third most common disease of the urinary tract, is a major health issue due to its high prevalence, occurrence, and recurrence. The hallmark of a stone that obstructs the ureter or renal pelvis is excruciating, intermittent pain that radiates from the flank to the groin or to the inner thigh. Stone size influences the rate of spontaneous stone passage. Our aim was to compare the efficacy & the frequency of stone-free patients after intervention at 1 week after extracorporeal shock wave lithotripsy (ESWL) and ureterorenoscopic (URS) manipulation for proximal ureteric stone (10–15 mm size). This randomized control trial was done in the department of Urology, KRL Hospital Islamabad from 18th Nov 2019 to 18th May 2020. After meeting the inclusion criteria, 100 patients were enrolled and were divided into two groups. The first group was treated with ESWL and the other with URS. Then, procedures were done. Follow-up was noted after 1 week in the stone clinic. The average age of the patients was 39.71 ± 10.17 years. Efficacy in the ESWL group was found in 68% cases while in the URS group, efficacy was noticed in 76% cases (P > 0.05). Male patients were three times at a higher risk of recurrence as compared to females. This study concluded that both ESWL and URS are equally effective statistically in terms of the frequency of stone-free patients at 1 week for proximal ureteric stone (10–15 mm size).
subject: Original Article: Urethral
  topic: section
subject: proximal ureteric stone
  topic: keywords
subject: extracorporeal shock wave lithotripsy
  topic: keywords
subject: ureterorenoscopic
  topic: keywords
subject: manipulation
  topic: keywords
subject: Endourology
  topic: keywords
subject: Stoneclinic
  topic: keywords
creator: Kashif Bangash
creator: Arsalan Riaz
creator: Hassan Mumtaz
creator: Farrukh Zaman
creator: Inam Malkani
creator: Muhammad Danish Qureshi
creator: Fayyaz Haider Ali
creator: Khursheed Anwar
rights: Copyright (c) 2021 Kashif Bangash, Arsalan Riaz, Hassan Mumtaz, Farrukh Zaman, Fayyaz Haider Ali, Khursheed Anwar, Inam Malkani, Muhammad Danish Qureshi http://creativecommons.org/licenses/by/4.0
date: 2020-05-15
publication date: 2020-05-15
starting page: 30
ending page: 37
doi: 10.15586/jrenhep.v5i1.97

Paradigm Shift in Etiology of Upper Gastrointestinal Bleed in Emergency Department
type: item
description: Acute upper gastrointestinal (UGI) bleed is an emergency requiring immediate intervention. Recent data have shown peptic ulcer disease (PUD) to be the commonest cause of UGI bleed. We aimed to evaluate all patients with UGI bleed reporting in the emergency department. A cross-sectional, observational study from a tertiary care center; evaluated all patients with UGI bleed presenting to the outpatient and emergency departments between December 2017 and December 2018. A total of 356 patients with UGI bleed were enlisted for diagnostic and therapeutic endoscopy. Variceal bleed was present in 231 (65%) [cir-rhosis 217 (61%) vs noncirrhotic 14 (4%)] patients, nonvariceal bleed was present in 93 (26%) [cirrhosis 22(6%) vs noncirrhotic 71(20%)] patients, and no cause was determined in 32 (9%) patients. Among cirrhotic patients, alcoholic liver disease (n = 172) was the most common, followed by cryptogenic cirrhosis (n = 32), and cirrhosis related to Hepatitis B (n =7) and hepatitis C virus (n =22), and AIH (n = 6). Among variceal noncirrhotic causes, noncirrhotic portal hypertension was present in 14 patients. In the noncirrhotic, nonvariceal group, causes of UGI bleed included esophagitis (n = 26), erosive gastritis (n = 9), and Mallory Weiss Tear (n = 7), followed by PUD (n = 23), carcinoma stomach (n = 3), carcinoma esophagus (n = 2), and duodenal polyp (n= 1). Nonvariceal cirrhotic patients had portal hypertensive gastropathy (n = 8), PUD (n = 5), duodenal erosions (n = 1), esophagitis (n= 7), and antral varix (n = 1). Interestingly, even in the nonvariceal group, alcohol was the underlying cause of UGI bleed in majority of the patients with esophagitis and erosive gastritis. Alcohol was the commonest cause of UGI bleed in majority of the cases with or without chronic liver disease, followed by PUD in small numbers in the emergency department.
subject: Original Articles Hepatology
  topic: section
subject: alcoholic liver disease
  topic: keywords
subject: peptic ulcer disease
  topic: keywords
subject: upper gastrointestinal bleed
  topic: keywords
creator: Tarana Gupta
creator: Sandeep Goyal
rights: Copyright (c) 2021 Tarana Gupta, Sandeep Goyal http://creativecommons.org/licenses/by/4.0
date: 2021-03-16
publication date: 2021-03-16
starting page: 14
ending page: 18
doi: 10.15586/jrenhep.v5i1.93

Acute Alcohol Tissue Damage: Protective Properties of Betaine
type: item
description: Teenage binge drinking is a major health issue; however, there is a paucity of data on liver injury. Herein, we investigated how acute ethanol affects juvenile hepatic cells through changes in oxidative stress, apoptosis, and liver function, as well as the ability of betaine, which can replenish the antioxidant glutathione and mitigate oxidative injury. Juvenile male Wistar rats were given either water or betaine (2% w/v) for 6 days and treated with either saline 0.15 mol/L NaCl or ethanol (75 mmol/kg body weight). After 24 h, liver enzymes, oxidative damage, apoptosis, and parameters of antioxidant enzyme activity were examined. Acute ethanol increased hepatic enzymes (99%, P < 0.05). Total protein and albumin levels were reduced by 14 and 18% (P < 0.001), respectively, which was prevented by betaine treatment. Cytosolic cytochrome c increased by 59% (P < 0.05), corresponding to a decrease in mitochondrial cytochrome c content, which was ameliorated with betaine. Cytosolic glutathione peroxidase was reduced with alcohol (P < 0.05) and was prevented with betaine. Subtle changes were observed in catalase, superoxide dismutase, glutathione reductase, and complex I activity after ethanol treatment. In summary, whilst juvenile animals appear to have higher basal levels of antioxidant enzymes, betaine conferred some protection against alcohol-induced oxidative stress.
subject: Original Articles Hepatology
  topic: section
subject: adolescents
  topic: keywords
subject: antioxidants
  topic: keywords
subject: binge drinking
  topic: keywords
subject: liver
  topic: keywords
subject: oxidative stress
  topic: keywords
creator: Lucy Petagine
creator: Hannah Everitt
creator: Victor R. Preedy
creator: Roy A. Sherwood
creator: Vinood B. Patel
rights: Copyright (c) 2021 Lucy Pentagine, Hannah Everitt, Victor Preedy, Roy Sherwood, Vinood Patel http://creativecommons.org/licenses/by/4.0
date: 2021-03-19
publication date: 2021-03-19
starting page: 19
ending page: 29
doi: 10.15586/jrenhep.v5i1.96

The Indirect Implication of SARS-CoV-2 Resulting in Kayexalate Toxicity in a Patient with Acute Kidney Injury
type: item
description: The clinical features of corona virus disease 2019 (COVID-19) are variable, but the majority of patients experience mild flu-like symptoms. The cases of severe disease include complications such as progressive pneumonia, acute kidney injury (AKI), multi-organ failure, and even death. This paper explores the association between COVID-19 and its effect on multiple organ systems and how the subsequent treatment of this dis-ease can itself lead to morbidity and mortality. We present a case that emphasizes the life-threatening gastrointestinal complications associated with the treatment of AKI in a patient with COVID-19. We conclude that the patients whose treatment regimens utilize medical resins should be closely monitored for gastrointestinal complications so as to mitigate the known adverse effects associated with these drugs, such as colonic mucosal ulceration, perforation, or even death.
subject: Case Reports Nephrology
  topic: section
subject: acute kidney injury
  topic: keywords
subject: colonic perforation
  topic: keywords
subject: COVID-19
  topic: keywords
subject: Kayexalate
  topic: keywords
subject: resins
  topic: keywords
subject: sevelamer
  topic: keywords
creator: Charles E Middleton
creator: William Daley
creator: Neha Varshney
rights: Copyright (c) 2021 Charles E. Middleton IV, William Daley, Neha Varshney http://creativecommons.org/licenses/by/4.0
date: 2021-02-27
publication date: 2021-02-27
starting page: 6
ending page: 13
doi: 10.15586/jrenhep.v5i1.88

Comparison of Transient Elastography and Liver Biopsy in Assessing Fibrosis in Patients with Nonalcoholic Fatty Liver Disease
type: item
description: Nonalcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease. Ultrasound-based transient elastography (TE) or TE of the liver is a noninvasive tool for effectively evaluating liver stiffness and fibrosis. The study aimed to compare the accuracy of TE as assessed by Fibroscan with liver biopsy in staging fibrosis in patients with NAFLD. Consecutive NAFLD patients (N = 72) were prospectively enrolled. TE evaluation was performed with Fibroscan and compared with liver biopsy, which is a reference standard. Fibrosis was staged according to the METAVIR scoring system (Meta-analysis of Histological Data in Viral Hepatitis). TE scores and biopsy-related fibrosis stages were correlated. Diagnostic accuracy (sensitivity, specificity, positive and negative predictive values) of TE was evaluated. Data were analyzed using software R v3.6.3. Liver biopsy showed that 36.11% of patients did not exhibit fibrosis, whereas 25, 16.67, 15.28, and 6.94% of patients had stage F1 (portal/mild fibrosis), F2 (periportal/moderate fibrosis), F3 (bridging/severe fibrosis), and F4 (cirrhosis/advanced fibrosis), respectively. TE showed that 50% of patients had cirrhosis, whereas 20.83,15.28, and 13.86% of patients had mild, moderate, and severe fibrosis, respectively. TE had 71% accuracy, 89% sensitivity, and 38% specificity in diagnosing the severity of fibrosis. Hence, it can be implemented as a noninvasive alternative diagnostic tool for understanding the severity of fibrosis in patients with NAFLD. Moreover, it can also be used for quick early diagnosis of NAFLD, reliable staging of fibrosis, and understanding the need for liver transplantation in patients with NAFLD.
subject: Original Articles Hepatology
  topic: section
subject: Biopsy
  topic: keywords
subject: Elasticity imaging techniques
  topic: keywords
subject: Fibrosis
  topic: keywords
subject: Liver cirrhosis
  topic: keywords
subject: Non-alcoholic fatty liver disease
  topic: keywords
creator: Gaurav Bachhav
creator: Locheruvapalli Venkateshappa Lokesh
creator: Balekuduru Avinash
creator: Manjunath Patil
creator: Bonthala Subbara Satyaprakash
creator: Sindhuvalada Karnam Ravikiran
rights: Copyright (c) 2021 Gaurav Bachhav, Lokesh Locheruvapalli Venkateshappa, Balekuduru Avinash, Manjunath Patil, Satyaprakash Bonthala Subbara , Sindhuvalada Karnam Ravikiran http://creativecommons.org/licenses/by/4.0
date: 2021-05-18
publication date: 2021-05-18
starting page: 38
ending page: 43
doi: 10.15586/jrenhep.v5i1.90

Histological Evaluation of Extended Criteria Donors: Donor’s Kidney Biopsy and Graft Outcome after 5 Years of Transplantation
type: item
description: Pre-transplant kidney biopsy is routinely used to decide whether kidneys from marginal donors should be transplanted as single or double trans-plantation. This is a 5-year extension of the follow-up of a previous study. In that study, graft outcomes were compared retrospectively between a group of 44 recipients of a single kidney graft from an extended criteria donor and a Karpinski histological score of ≤3, and another group of 56 recipients of a single transplant with a Karpinski histological score of 4 or 5. After 5 years of transplantation, there was no difference between the two groups in terms of recipient’s serum creatinine levels (1.8 ± 0.5 vs 1.9 ± 0.6 mg/dL, P = 0.5), creatinine clearance (53 ± 23 vs 49 ± 27.0 mL/min, P = 0.6), or the rates of graft loss (41% vs 49%,P = 0.5). Therefore, the choice between single and double transplant should not be made only on the basis of histological score but should be done together with the evaluation of donor’s clinical parameters, especially the renal function.
subject: Original Articles Nephrology
  topic: section
subject: extended criteria donors
  topic: keywords
subject: Karpinski histological score
  topic: keywords
subject: kidney transplantation
  topic: keywords
subject: pre-implantation kidney biopsy
  topic: keywords
creator: Paolo Carta
creator: Emma Bartaletti
creator: Giulia Ghiandai
creator: Leonardo Caroti
creator: Aida Larti
creator: Lorenzo Di Maria
creator: Lino Cirami
rights: Copyright (c) 2020 Paolo Carta, Emma Bartaletti, Giulia Ghiandai, Leonardo Caroti, Aida Larti, Lorenzo Di Maria, Lino Cirami http://creativecommons.org/licenses/by/4.0
date: 2020-11-07
publication date: 2020-11-07
starting page: 61
ending page: 66
doi: 10.15586/jrenhep.v4i2.77

HBV Hepatitis and Related Renal Nephropathies: Pathogenesis and Treatment
type: item
description: The extrahepatic manifestations of hepatitis B virus (HBV) infection include reactive arthritis, vasculitis (panarteritisnodosa), and primary glomerulonephritis (membranous nephropathy, membranoproliferative glomerulonephritis, and, less frequently, IgA nephropathy, focal and segmental glomerulosclerosis, and minimal change disease). No specific histomorphological patterns have been reported in association with HBV infection. The treatment of HBV-related glomerulopathies is essentially antiviral. Peginterferon and nucleos(t)ide drugs are the treatment of choice. Corticosteroids have been proved to be ineffective (except in panarteritisnodosa), while immunosuppressants can lead to exacerbation of HBV infection.
subject: Review Nephrology
  topic: section
subject: antiviral treatment
  topic: keywords
subject: HBcAg
  topic: keywords
subject: HBeAg
  topic: keywords
subject: HBsAg
  topic: keywords
subject: hepatitis B-associated glomerulonephritis
  topic: keywords
creator: Maurizio Salvadori
creator: Aris Tsalouchos
rights: Copyright (c) 2020 Maurizio Salvadori, Aris Tsalouchos http://creativecommons.org/licenses/by/4.0
date: 2020-11-09
publication date: 2020-11-09
starting page: 67
ending page: 74
doi: 10.15586/jrenhep.2020.85

Hepatocellular Carcinoma: A Review
type: item
description: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death worldwide. Chronic liver disease due to viral hepatitis, alcohol, non-alcoholic fatty liver disease, etc are risk factors for HCC development. Triphasic contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (MRI) abdomen are modalities for HCC diagnosis best for lesions >2 cm size. For lesions <2 cm size, liquid biopsy with the determination of cell-free DNA in the blood is a newly emerging technique for diagnosis as well as for the planning of molecular targeted therapy. With the new concept of “Treatment stage migration”, the updated Barcelona clinic liver cancer (BCLC) algorithm for HCC management allows the best treatment modality for an individual patient. In addition to definitive therapy of resection and liver transplantation, palliative therapies like ablation, transarterial embolization, and others can be used. Among molecular targeted therapies for advanced BCLC stage C HCC, lenvatinib as first line, regorafenib and cabozantinib as second line therapy have been approved recently. The checkpoint inhibitors (CPIs), nivolumab and pembrolizumab, have revolutionized oncology practice in other solid organ cancers and have shown promising results in HCC management.
subject: Review Hepatology
  topic: section
subject: Barcelona clinic liver cance
  topic: keywords
subject: checkpoint inhibitors
  topic: keywords
subject: hepatocellular carcinoma
  topic: keywords
subject: liver transplantation
  topic: keywords
creator: Tarana Gupta
rights: Copyright (c) 2020 Tarana Gupta http://creativecommons.org/licenses/by/4.0
date: 2020-09-18
publication date: 2020-09-18
starting page: 51
ending page: 60
doi: 10.15586/jrenhep.v4i2.84

Yersinia enterocolitica Infection in Patients Undergoing Intermittent Hemodialysis
type: item
description: End-stage renal disease is the last stage of chronic kidney disease and affects more than 2 million patients worldwide. The infection-related hospitalization is an important cause of excess morbidity and mortality in this group of patients. Yersinia enterocolitica (YE) is one of the bacteria that hemodialysis (HD) patients can occasionally be infected with. The most common symptoms are fever and mild diarrhea, which is self-limited. However, in HD patients, especially in iron-overloaded cases, severe watery or bloody diarrhea can occur. The consumption of undercooked food by patients should sensitize the physician to the possibility of YE infection. Clinically, YE is difficult to diagnose due to nonspecific symptoms and the relatively low prevalence of yersiniosis, compared to other causative pathogens in dialysis patients. There is little information about yersiniosis in HD patients. For this reason, this review aims to summarize the current knowledge on YE infection in HD patients, with the main objective of expounding the problems in identifying, diagnosing, and treating yersiniosis in HD patients.
subject: Review Nephrology
  topic: section
subject: end-stage renal disease
  topic: keywords
subject: enteric yersiniosis
  topic: keywords
subject: hemodialysis
  topic: keywords
subject: Yersinia enterocolitica
  topic: keywords
creator: Hsu Chueh Lin
creator: Leszek Niepolski
rights: Copyright (c) 2020 Chueh lin Hsu, Dr. Leszek Niepolski http://creativecommons.org/licenses/by/4.0
date: 2020-09-07
publication date: 2020-09-07
starting page: 41
ending page: 50
doi: 10.15586/jrenhep.v4i2.80

Direct-Acting-Antivirals Anti-hepatitis C Virus in Renal Transplant Patients: Relevance of Pharmacologic Interaction
type: item
description: Renal transplantation in patients affected by hepatitis C virus (HCV) infection has been a serious problem because of the use of immunosuppressants. HCV virus may be more aggressive in both the liver and the kidney. Several posttransplantation pathologies are known to be ascribed to the HCV virus. Virus eradication has been historically attempted with interferon (IFN) and ribavirin with poor results. In addition, IFN given posttransplantation may cause severe acute rejection. The introduction of direct antiviral agents (DAA) has revolutionized the treatment, and now it is possible to treat renal transplant patients with these agents leading to a HCV-free status in 3 months without the use of IFN. The major problem caused by these agents is their interference with the immunosuppressive agents. The pharmacokinetics of DAA and immunosuppressants often meet the same metabolic pathways and use the same cytochromes or proteic complexes. In some cases, this may lead to high or low immunosuppressant levels with the risk of rejection. In other cases, the DAAs are interested and they may be increase or decrease in a dangerous way. Therefore, a strict monitoring is always recommended.
subject: Commentary
  topic: section
subject: direct antiviral agents
  topic: keywords
subject: HCV-related diseases
  topic: keywords
subject: immunosuppressants
  topic: keywords
subject: metabolic pathways
  topic: keywords
subject: posttransplant complications
  topic: keywords
creator: Maurizio Salvadori
creator: Aris Tsalouchos
rights: Copyright (c) 2020 Maurizio Salvadori, Aris Tsalouchos http://creativecommons.org/licenses/by/4.0
date: 2020-08-03
publication date: 2020-08-03
starting page: 29
ending page: 33
doi: 10.15586/jrenhep.v4i2.79

Study of Urinary Alpha Glutathione-S-Transferase in Children with Idiopathic Nephrotic Syndrome
type: item
description: Glomerulopathy associated with recurrent or persistent proteinuria may lead to progressive tubulointerstitial fibrosis. Early detection of tubulointerstitial fibrosis may result in a more favorable outcome of chronic kidney disease (CKD) because nephroprotective treatment may be instituted in due course. One of the early markers of tubulointerstitial fibrosis is glutathione S-transferase (GST). The aim of this study was to determine urinary alpha-GST in children with idiopathic nephrotic syndrome (INS), either in remission or relapse. This case–control study included 40 children with primary nephrotic syndrome (NS), either in remission or relapse. Also, 40 healthy children, age- and sex-matched as controls, were selected from the outpatients and the pediatric nephrology unit of Al-Zahraa Hospital, Al-Azhar University. Urinary alpha-GST was investigated in the study groups on the same lines as that of routine investigations of INS. Children with INS have significantly higher urinary GST either in remission or relapse, it was (5.23 ± 1.90) ng/mL, (5.32 ± 1.52) ng/mL respectively compared with healthy controls, it was (2.59 ± 1.12) ng/mL with (P = 0.001). A positive correlation between urinary alpha-GST and body weight BW, height, body mass index (BMI), white blood cells (WBCs) count, erythrocyte sedimentation rate, serum (cholesterol, triglyceride [TG]) level, blood urea nitrogen (BUN), and duration of the disease. Urinary alpha-GST was increased in children with NS even after remission, and it consequently led to oxidative stress and tubulointerstitial fibrosis. Nephroprotective treatment is recommended even in cases with INS, either in remission or relapse.
subject: Original Articles Nephrology
  topic: section
subject: children
  topic: keywords
subject: nephrotic syndrome
  topic: keywords
subject: urinary alpha-GST
  topic: keywords
creator: Manal Abdel-Salam
creator: Houriah Ahmed Allam
creator: Shams Kholoussi
creator: Asmaa Abd El-Wakeel Ibrahim
creator: Shaimaa Adel Abd El-Hakeim
rights: Copyright (c) 2020 Manal Abdel-Salam, Houriah Ahmed Allam, Shams Kholoussi, Asmaa Abd El-Wakeel Ibrahim, Shaimaa Adel Abd El-Hakeim http://creativecommons.org/licenses/by/4.0
date: 2020-08-15
publication date: 2020-08-15
starting page: 34
ending page: 40
doi: 10.15586/jrenhep.v4i3.78

Acute Kidney Injury and Acute Liver Failure in Leptospira Infection and Weil’s Syndrome
type: item
description: Leptospirosis is considered a zoonosis acquired predominantly from contaminated surfaces and water, more commonly in emerging countries with limited sanitary conditions. Leptospira in the host unleashes an immune response that explains the symptoms and clinical signs; once it reaches the kidney and liver tissue, it can manifest with alterations that lead to acute and chronic diseases in both organs. Weil’s syndrome is the best known clinical manifestation with jaundice and acute kidney injury that could lead to multiple organ failure and death. For its diagnosis, there are simplified scores such as the SPiRO score, the microbiological criteria by microscopy or serological tests; the treatment focuses on antibiotics and, if necessary, provides organic support until the infection is curtailed. The purpose of this review was to address the impact of Leptospira infection on the kidney and liver, the mechanisms of organ damage, the clinical presentation, and diagnosis and management of this disease.
subject: Review Nephrology
  topic: section
subject: leptospirosis
  topic: keywords
subject: acute kidney injury
  topic: keywords
subject: acute liver failure
  topic: keywords
creator: Jonathan S Chavez-Iniguez
creator: Said Cabrera-Aguilar
creator: Guillermo Garcia-Garcia
creator: Juan Armendariz-Borunda
rights: Copyright (c) 2020 Jonathan S Chávez-Iñiguez, Guillermo Garcia-Garcia, Jose Said Cabrera-Aguilar, Juan Armendáriz-Borunda http://creativecommons.org/licenses/by/4.0
date: 2020-06-26
publication date: 2020-06-26
starting page: 21
ending page: 28
doi: 10.15586/jrenhep.2020.75

Manganese-Induced Nephrotoxicity Is Mediated through Oxidative Stress and Mitochondrial Impairment
type: item
description: Manganese (Mn) is an essential element that is incorporated in various metabolic pathways and enzyme structures. On the other hand, a range of adverse effects has been described in association with Mn overexposure. Mn is a well-known neurotoxic agent in mammals. Renal injury is another adverse effect associated with Mn intoxication. No precise mechanism for Mn nephrotoxicity has been identified so far. The current study was designed to evaluate the potential mechanisms of Mn-induced renal injury. Rats were treated with Mn (20 and 40 mg/mL, respectively, in drinking water) for 30 consecutive days. Markers of oxidative stress, as well as several mitochondrial indices, were assessed in the kidney tissue. Renal injury was evident in Mn-treated animals, as judged by a significant increase in serum BUN and creatinine. Moreover, urinalysis revealed a significant increase in urine glucose, phosphate, and protein in Mn-treated rats. Kidney histopathological alterations, including tubular atrophy, interstitial inflammation, and necrosis, were also detected in Mn-treated animals. Biomarkers of oxidative stress, including an increment in reactive oxygen species (ROS), lipid peroxidation, and oxidized glutathione (GSSG), were detected in Mn-treated groups. On the other hand, kidney glutathione (GSH) stores and total antioxidant capacity were depleted in Mn groups. Mn exposure was associated with significant mitochondrial depolarization, decreased mitochondrial dehydrogenases activity, mitochondrial permeabilization, and depletion of adenosine triphosphate (ATP) content. These data highlight oxidative stress and mitochondrial impairment as potential mechanisms involved in Mn-induced renal injury.
subject: Original Articles Nephrology
  topic: section
subject: energy crisis
  topic: keywords
subject: manganism
  topic: keywords
subject: mitochondria
  topic: keywords
subject: renal failure
  topic: keywords
subject: serum electrolyte waste
  topic: keywords
creator: Amir Mohammad Niknahad
creator: Mohammad Mehdi Ommati
creator: Omid Farshad
creator: Leila Moezi
creator: Reza Heidari
rights: Copyright (c) 2020 Reza Heidari, Milad Niknahad, Mohammad Mehdi Ommati, Omid Farshad, Leila Moezi http://creativecommons.org/licenses/by/4.0
date: 2020-06-09
publication date: 2020-06-09
starting page: 1
ending page: 10
doi: 10.15586/jrenhep.2020.66

The Novel Coronavirus 2019 Epidemic and the Kidneys
type: item
description: The Severe Acute Respiratory Syndrome Coronavirus 2 is a recent disease that originated in China by the end of 2019. The origins of the dis-ease can be traced to bats, but it has been transmitted to humans, and the inter-human transmission is particularly rampant which has led to a pandemic of unseen proportions. The organ principally involved is the lungs, and severe pneumonia with lack of oxygen leads to fatalities. The aim of this review was to study the involvement of the kidneys with regard to COVID-19 infection and how the disease may affect people on hemodialysis or those who have undergone a kidney transplant. Indeed, the virus, in addition to the lungs, may affect other vascularized organs to a common receptor on lung epithelium and the endothelium of any organ. The kidney, which has a large endothelium surface, is affected, and COVID-19 may lead to acute renal failure. On the other hand, the virus may easily spread among people who are on hemodialysis three times a week. People on hemodialysis may have low immunity, and the virus may have dangerous effects on such people. Finally, renal transplant patients may be easily affected, and the virus may have severe consequences, even death. We will summarize the principal prophylactic measures to be adopted and the therapeutic measures available. Clearly due to the recent occurrence of the pandemic the majority these measures lack a basis in evidence-based medicine and only highlight the efforts to limit COVID-19 induced damage.
subject: Review Nephrology
  topic: section
subject: acute kidney injury
  topic: keywords
subject: coronavirus disease
  topic: keywords
subject: hemodialysis patients
  topic: keywords
subject: renal transplant patients
  topic: keywords
subject: treatment of COVID-19
  topic: keywords
creator: Maurizio Salvadori
creator: Aris Tsalouchos
rights: Copyright (c) 2020 Maurizio Salvadori; Aris Tsalouchos http://creativecommons.org/licenses/by/4.0
date: 2020-06-15
publication date: 2020-06-15
starting page: 11
ending page: 20
doi: 10.15586/jrenhep.2020.76

An Update on Hepatorenal Syndrome
type: item
description: Hepatorenal syndrome (HRS) is one of the many potential causes of acute kidney injury (AKI) in patients with decompensated liver disease. HRS is associated with poor prognosis and represents the end-stage of a sequence of reductions in renal perfusion induced by progressively severe hepatic injury. The pathophysiology of HRS is complex with multiple mechanisms interacting simultaneously, although HRS is primarily characterised by renal vasoconstriction. A recently revised diagnostic criteria and management algorithm for AKI has been developed for patients with cirrhosis, allowing physicians to commence treatment promptly. Vasopressor therapy and other general management, such as antibiotic prophylaxis, need to be initiated whilst patients are assessed for eligibility for transplantation. Liver transplantation remains the treatment of choice for HRS but is limited by organ shortage. Other management options, such as transjugular intrahepatic portosystemic shunt, renal replacement therapy and molecular absorbent recirculating system, may provide short-term benefit for patients not responding to medical therapy whilst awaiting transplantation. Clinicians need to be aware of the pathophysiology and management principles of HRS to provide quality care for patients with multi-organ failure.
subject: Hepatorenal
  topic: section
subject: acute kidney injury
  topic: keywords
subject: hepatorenal syndrome
  topic: keywords
subject: molecular absorbent recirculating system
  topic: keywords
subject: renal replacement therapy
  topic: keywords
subject: ransjugular intrahepatic portosystemic shunt
  topic: keywords
creator: Samuel Chan
creator: Kenneth Au
creator: Ross Francis
creator: David W. Mudge
creator: David W. Johnson
creator: Tony Rahman
rights: Copyright (c) 2017 Samuel Chan, David W Johnson http://creativecommons.org/licenses/by/4.0
date: 2017-03-22
publication date: 2017-03-22
starting page: 55
ending page: 61
doi: 10.15586/jrenhep.2017.12

Plasmapheresis in the Management of Acute Pancreatitis due to Severe Hypertriglyceridemia—Reporting New Cases
type: item
description: Acute pancreatitis is a potentially life-threatening disease. If the diagnosis and the treatment are not prompt, it can rapidly evolve to a medical emergency. Severe hypertriglyceridemia, defined as above 1000 mg/dl, is the third most common cause of acute pancreatitis. Conventional management includes fat dietary restriction and pharmacological treatment; however, these measures take time to be effective. Plasmapheresis seems to be an alternative and safe adjunctive therapy because it allows the rapid reduction of the trigger agent in circulation. Its use, especially in severe cases, has been increasingly reported. The authors report three cases of severe hypertriglyceridemia-induced pancreatitis in which early plasmapheresis was successfully used with other supportive clinical management.
subject: Case Reports Hepatology
  topic: section
subject: acute pancreatitis
  topic: keywords
subject: plasmapheresis
  topic: keywords
subject: severe hypertriglyceridemia
  topic: keywords
creator: Andreia Campos
creator: Josefina Santos
creator: Cristina Freitas
creator: Ana Castro
creator: Sofia Santos
creator: Joa ̃o Pedro Pimentel
creator: Antonio Cabrita
rights: Copyright (c) 2017 Andreia Campos, Josefina Santos, Cristina Freitas, Ana Castro, Sofia Santos, JP Pimentel, António Cabrita http://creativecommons.org/licenses/by/4.0
date: 2017-02-03
publication date: 2017-02-03
starting page: 29
ending page: 34
doi: 10.15586/jrenhep.2017.3

Reprogrammed Cell‐based Therapy for Liver Disease: From Labto Clinic
type: item
description: A large number of patients are affected by liver dysfunction worldwide. Liver transplantation is the only efficient treatment in a variety of enduring liver disorders including inherent and end-stage liver diseases. The generation of human functional hepato-cytes in high quantities for liver cell therapy is an important goal for ongoing therapies in regenerative medicine. Reprogrammed cells are considered as a promising and unlimited source of hepatocytes, mainly because of their expected lack of immunogenicity and minimized ethical concerns in clinical applications. Despite gained advances in the reprogramming of somatic cells to functional hepatocytes in vitro, production of primary adult hepatocytes that can proliferate in vivo still remains inaccessible. As part of efforts toward translation of cell reprogramming science into clinical practice, more careful cell selection strategies should be integrated into improvement of dedifferentiation and redifferentiation protocols, especially in precision medicine where gene correction is needed. Furthermore, advances in cellular reprogramming highlight the need for developing and evaluating novel standards addressing clinical research interests in this field.
subject: Review Hepatology
  topic: section
subject: cell therapy
  topic: keywords
subject: gene editing
  topic: keywords
subject: liver transplantation
  topic: keywords
subject: regenerative medicine
  topic: keywords
subject: stem cells
  topic: keywords
creator: Amir Mehdizadeh
creator: Masoud Darabi
rights: Copyright (c) 2017 Amir Mehdizadeh, Masoud Darabi http://creativecommons.org/licenses/by/4.0
date: 2017-02-03
publication date: 2017-02-03
starting page: 20
ending page: 28
doi: 10.15586/jrenhep.2017.6

Renal Concerns in the Treatment of Chronic Hepatitis B with Tenofovir
type: item
description: Tenofovir, a third generation oral nucleos(t)ide analogue, currently represents one of the first-line drugs recommended for treating chronic hepatitis B virus (HBV) infection. After oral administration, tenofovir is mostly excreted in the urine by glomerular filtration and proximal tubular secretion. Hence, an impaired kidney function may lead to an increased renal exposure to the drug in patients with coexistent renal damage. This could further worsen kidney disease through different mechanisms of nephrotoxicity such as mitochondrial DNA depletion and tubular cytotoxicity. Despite several studies performed so far to assess tenofovir-related renal toxicity, data in HBV patients are not yet conclusive. Screening of risk factors for kidney disease before starting therapy and a careful monitoring of serum creatinine, glomerular filtration rate, serum phosphate and urine analysis during treatment are advocated to adjust the dose or stop treatment if needed. New biomarkers of tubular injury, such as neutrophil gelatinase associated lipocalin, could become helpful in the future for the timely identification and risk stratification of renal damage induced by tenofovir.
subject: Review Nephrology
  topic: section
subject: antiretroviral therapy
  topic: keywords
subject: hepatitis B
  topic: keywords
subject: NGAL
  topic: keywords
subject: nucleos(t)ide analogue
  topic: keywords
subject: tenofovir
  topic: keywords
creator: Giuseppe Coppolino
creator: Valeria Cernaro
creator: Laura Rivoli
creator: Angela Pinciaroli
creator: Davide Bolignano
rights: Copyright (c) 2017 Giuseppe Coppolino, Valeria Cernaro, Laura Rivoli, Angela Pinciaroli, Davide Bolignano http://creativecommons.org/licenses/by/4.0
date: 2017-03-23
publication date: 2017-03-23
starting page: 50
ending page: 54
doi: 10.15586/jrenhep.2017.11

Novel Therapeutic Strategies Targeting Molecular Pathways of Cystogenesis in Autosomal Polycystic Kidney Disease
type: item
description: Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease that results from mutations in PKD1 or PKD2. The disease is characterized by the progressive development of fluid-filled cysts derived from renal tubular epithelial cells that destroy the architecture of the renal parenchyma and lead to kidney failure. Until recently, the causes and the molecular pathways that lead to cystogenesis remained obscure. In the last decade, enormous progress has been made in understanding the pathogenesis of ADPKD and the development of new therapies. The purpose of this review is to update on the promising therapies that are being developed and tested based on knowledge of recent advances in molecular and cellular targets involved in cystogenesis.
subject: Review Nephrology
  topic: section
subject: adult autosomal polycystic kidney disease
  topic: keywords
subject: cystogenesis
  topic: keywords
subject: mTOR signaling
  topic: keywords
subject: somatostatin analogues
  topic: keywords
subject: vasopressin 2 receptors
  topic: keywords
creator: Maurizio Salvadori
creator: Aris Tsalouchos
rights: Copyright (c) 2017 Maurizio Salvadori http://creativecommons.org/licenses/by/4.0
date: 2017-03-15
publication date: 2017-03-15
starting page: 35
ending page: 49
doi: 10.15586/jrenhep.2017.10

Anaemia of Chronic Kidney Disease: What We Know Now
type: item
description: Our understanding of the pathophysiology of the anaemia of chronic kidney disease (CKD) has improved considerably in the last decade with the discovery of the iron regulatory peptide hepcidin. Reduced clearance of hepcidin and the presence of achronic inflammatory state contribute to elevated hepcidin levels in kidney disease. The recent discovery of the various factors and signalling pathways regulating hepcidin has opened up an exciting avenue for research into the development of newer agents that could treat anaemia of CKD. This review highlights our current understanding of iron metabolism in health, the regulators of hepcidin, issues associated with the current available therapies for the treatment of anaemia in CKD and potential novel therapies that could be available in the near future targeting the various factors that regulate hepcidin.
subject: Review Nephrology
  topic: section
subject: anaemia
  topic: keywords
subject: chronic kidney disease
  topic: keywords
subject: iron metabolism
  topic: keywords
subject: hepcidin
  topic: keywords
subject: inflammation
  topic: keywords
subject: erythropoietin-stimulating agents
  topic: keywords
creator: Anoushka R. Krishnan
creator: Debbie Trinder
creator: Anita C. G. Chua
creator: Aron Chakera
creator: Grant A. Ramm
creator: John K. Olynyk
rights: Copyright (c) 2017 Anoushka R. Krishnan, Debbie Trinder, Anita C.G. Chua, Aron Chakera, Grant A. Ramm, John K. Olynyk http://creativecommons.org/licenses/by/4.0
date: 2017-02-03
publication date: 2017-02-03
starting page: 11
ending page: 19
doi: 10.15586/jrenhep.2017.5