Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Glomerular pathology in liver cirrhosis is common in autopsies but is underdiagnosed antemortem. The most common pathologic findings are mesangial disease with immunoglobulin A deposits, and membranoproliferative glomerulonephritis. The latter is associated, most frequently, with hepatitis C infection and cryoglobulinemia. We describe a patient with longstanding liver cirrhosis who presented with a nephritic and nephrotic syndrome. Membranoproliferative glomerulonephritis was diagnosed on kidney biopsy. There was no clinical, laboratory or histologic evidence of hepatitis C infection or cryoglobulinemia. The different aspects of "cirrhotic glomerulonephritis" are discussed and the need for searching for this underdiagnosed condition in patients with chronic liver disease is emphasized.
 ...
PMID:Cirrhotic glomerulonephritis: an underdiagnosed condition. 900 58

The strong association of HCV infection with MC-II and the selective concentration of the virus with the WA mRF in the cryoglobulins are compelling suggestions that the virus is directly involved in production of the mRF and the pathophysiology of MC-II. There is, however, only limited data on HCV involvement in both processes. In cutaneous vasculitis, which is the most prevalent clinical feature of the disease, there is evidence that complexes of HCV, mRF and IgG are formed in situ from components of the cryoglobulins that are present in the blood in a dissociated state. It is postulated that local factors, cooling and stasis predispose to formation of these lesions in the lower limbs. However, since cutaneous vasculitis does not correlate with cryoglobulin levels and may not be induced by cold challenge, other factors may be involved. In particular, the conditions which activate the vascular endothelial cells, leading to the leukocytoclastic vasculitis, require delineation. In contrast to cutaneous vasculitis, HCV RNA has not been prominently detected in immune complexes in MPGN lesions and has not been detected at all in the peripheral neuropathy lesions. These preliminary observations suggest that different pathophysiological processes are involved in for these lesions than in cutaneous vasculitis. From the correlation of remission of disease with decreased cryoglobulinemia and viremia in treated patients with MC-II, and from immunohistological data on the hepatitic lymphoid follicles in MC-II (see chapter 7), it appears that an antigen-driven benign proliferation of B cells is responsible for production off mRF and cryoglobulinemia. New findings have suggested that one mechanism for developing mixed cryoglobulinemia may be that HCV-VLDL complexes that contain apo E2 are poorly endocytosed by the LDLR, which may be a major route of entry of the virus to the cell; persistence of the complexes in the circulation may then stimulate mRF production. This new hypothesis is based only on initial in vitro observations and require independent confirmation and validation in vivo. From indirect clinical evidence it has also been postulated that mRF in some patients may limit the cytopathology in MC-II, resulting in a lower prevalence of cirrhosis in these patients. These findings suggested another hypothesis, which is that the mRF prevents spread of infection to hepatocytes and other permissive and nonpermissive cells by blocking endocytosis of HCV-VLDL complexes by the LDLR. Furthermore, data on the composition of cryoglobulins, the molecular composition of WA mRF and the characterization of monoclonal B cells in the liver of patients with MC-II (see chapter 7) suggest that a specific population of B cells may be involved in the host response to HCV infection. These are B cells that proliferate with little or no somatic mutations of the immunoglobulin genes, are self-replicating, are stimulated by self antigens in a T cell-independent manner and bear the CD5 marker. The proliferation of this B cell population may be the host's response to the attempt by the virus to circumvent the immune response by complexing with host lipoproteins. It is proposed that HCV complexed to VLDL is the antigen that directly stimulates the proliferation of these primordial type B cells. Testing of these hypotheses may produce insights not only into the etiology of mixed cryoglobulinemia but possibly into the mechanisms by which HCV circumvents the immune response and established chronic infection.
 ...
PMID:The etiology and pathophysiology of mixed cryoglobulinemia secondary to hepatitis C virus infection. 926 35

We analyzed 137 cases of renal biopsies at the Department of Pathology from 2001 to 2007. The average age was 30.6 years (range, 13-72) for males and 32.9 years (range, 11-75) for females. The male to female ratio was 1.6: 1. The most common clinical syndromes for performing renal biopsy were nephrotic syndrome (81.6%) followed by asymptomatic urinary abnormalities (5.8%), nephritic syndrome (3.6%), hypertension (2.9%), chronic kidney disease (2.2%), acute renal failure (2.2%), cirrhosis (0.7%) and transplant rejection (0.7%). The major glomerular diseases in descending order of frequency were membranous glomerulonephritis (MGN; 42.3%), membranoproliferative glomerulonephritis (MPGN; 21.9%), minimal change disease (MCD; 10.2%), focal segmental glomerulosclerosis (FSGS; 8.0%), IgA nephropathy (2.9%), post infectious glomerulonephritis (GN) (2.2%), chronic GN (2.2%), tubulointerstitial nephritis (TIN; 1.5%), lupus nephritis (1.5%), focal proliferative GN (1.5%), Clq nephropathy (1.5%), amyloidosis (1.5%) and other minor form of glomerular diseases (2.8%). The pattern ofglomerulonephritis in our study is different from the reports of other developing countries. It could be due to various races and altered environmental condition. The information obtained from these results can be used as baseline data for making efficient research in Nepalese population in the future. The higher frequency of MGN and MPGN among Nepalese in comparison with other developing countries deserves further evaluation.
 ...
PMID:Hisopathological spectrum of glomerular disease in nepal: a seven-year retrospective study. 1882 37