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

The management of edematous patients has been a matter of medical concern from since the beginning of time. Richard Bright provided a new insight by recognizing the association of coagulable urine with disease of the kidneys. There had been much debate about the frequent dissociation between uremia and edema. Strauss revealed that in uremia without edema there was a retention of nitrogen metabolites, whereas in proteinuric edematous patients there was a retention of chloride and water. He concluded that edema was due solely to the retention of sodium chloride. Though underfilling theory was proposed as a possible mechanism for the development of edema in nephrotic syndrome and liver cirrhosis, several evidences against this theory have been reported in these 10 years. An intrarenal disturbance of sodium excretion related to the renal disease, liver diseases or heart failure may be the primary factors governing sodium retention. Further studies are necessary for better understanding of the mechanisms of the sodium and water retention in edema.
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PMID:[A history of edema: advances in the pathogenesis and management]. 1567 10

As the prevalence of chronic liver disease and chronic kidney disease (CKD) increase, clinicians are likely to be increasingly faced with difficult diagnostic, treatment, and ethical challenges when facing both of these diseases in a single patient. Alterations in creatinine formation and elimination in cirrhotic patients render creatinine-based estimates of glomerular filtration rate and dialysis adequacy less accurate in this population. Furthermore, differentiating signs and symptoms of uremia from hepatic disease may be difficult and clear indications for renal replacement therapy (RRT) in these patients have not been defined. Hemodialysis is associated with a high rate of complications and has not been shown to prolong life in cirrhotic patients with acute renal failure (ARF), but has not been carefully examined in those with CKD. Peritoneal dialysis is, similarly, unhelpful in chronic liver disease complicated by ARF, but has been found to be a viable option in some cirrhotic patients with CKD. Continuous RRT is generally tolerated by patients with decompensated cirrhosis and either acute or chronic renal failure and may act to bridge patients to liver transplantation. Given the poor underlying survival of cirrhotic patients with renal failure, clinicians should carefully consider the utility of RRT in each patient.
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PMID:Renal replacement therapy in patients with chronic liver disease. 1593 68

A qualitative abnormality of platelet function should be considered in patients with mucocutaneous bleeding in the absence of thrombocytopenia or von Willebrand disease. Antiplatelet drugs are the most common cause of acquired platelet disorders leading to bleeding. Uremia, hepatic cirrhosis, myeloma and related disorders, polycythemia vera, essential thrombocythemia, and cardiopulmonary bypass have long been recognized as clinical situations in which platelet dysfunction may contribute to bleeding. When an acquired platelet disorder is suspected, it is useful to examine platelet function by measuring the bleeding time, examining platelet-dependent closure time in a platelet function analyzer and performing platelet aggregometry. When a specific acquired platelet disorder is diagnosed, many treatment options are available including controlling the underlying disease, giving platelet transfusions and administering a hemostatic drug.
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PMID:Acquired disorders of platelet function. 1630 11

The prevalence and incidence of hepatitis B in hemodialysis patients in Croatia have been estimated to 1.3% and 0.03%, respectively. HBV infection in dialysis patients is usually asymptomatic, has a prolonged course, and progresses to chronic HBsAg hepatitis in 50% of cases. Some 15%-40% of HBsAg carriers on dialysis will develop cirrhosis, liver decompensation or hepatocellular carcinoma. Strict adherence to the standard infection prevention measures, continuous monitoring of HBV markers in patients on hemodialysis, patient and personnel immunization and hepatitis B treatment in hemodialyzed patients are mandatory. Each new patient in a dialysis center must be tested for HBV markers irrespective of prior immunization. All patients in the center should be routinely screened every 3-4 months. HBV immunization is mandatory for all patients on dialysis. In patients with uremia the anti-HBs antibody production is decreased (antibodies will develop in 50%-60% of cases after immunization). It is recommended to immunize all patients with progressive kidney disease, preferably in the preterminal stage. Hepatitis B therapy is recommended in all patients with biopsy proven chronic liver disease. Patients should be treated with standard interferon alpha and/or lamivudine, or peginterferon alpha monotherapy. Hepatitis B treatment is most important in kidney and/or liver transplant candidates. HBV immunization is obligatory for all hospital personnel who are in close contact with infected patients and infective materials.
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PMID:[Prevention and treatment of hepatitis B in patients on hemodialysis and vaccination of hemodialysis health personnel against hepatitis B]. 1638 Dec 47

The structural elucidation of advanced glycation end-product (AGE)-modified proteins and quantitative analysis of free AGEs have been successfully performed, by use of mass spectrometry (MS) in plasma and tissues of patients with AGE-related diseases, such as diabetes mellitus, uremia, cataract, and liver cirrhosis. Matrix-assisted laser desorption/ionization (MALDI)-MS made it possible to directly analyze the AGE-modified proteins such as albumin and IgG. However, because the direct structural analysis of intact AGE-modified proteins is often not easy due to the formation of broad and poorly resolved peaks, peptide mapping after enzymatic hydrolysis was introduced into the analysis of AGE-modified proteins and the site-specific analysis of defined AGEs by MALDI-MS. Liquid chromatography/electrospray ionization mass spectrometry (LC/ESI-MS) has been employed not only for the structural elucidation of enzymatically hydrolyzed AGEs-modified peptides but also for simultaneous quantification of free AGEs in plasma and tissues of patients. Based on many studies that use MS for the analysis of AGEs, there is no doubt as to the important role of protein-linked AGEs in several diseases.
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PMID:Mass spectrometry for the study of protein glycation in disease. 1652 5

A 64-year-old man was admitted because of abdominal fullness, edema and anorexia. He had come to our hospital for treatment of liver cirrhosis and diabetic nephropathy for 1 year. We started diuretics and human albumin intravenous administration. Although the edema disappeared and abdominal fullness improved a little, blood urea nitrogen (BUN) and serum creatinine became elevated, hepatic function deteriorated and he lost his appetite. We consequently started continuous ambulatory peritoneal dialysis (CAPD) in order to control ascites and uremia. Abdominal fullness, appetite and BUN and serum creatinine improved without hepatic function deterioration. It might be important to start CAPD to control ascites although serum creatinine levels might be slightly elevated.
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PMID:A case report of a diabetic nephropathy patient with cirrhotic ascites treated by peritoneal dialysis. 1730 79

Fever is one of the more common chief complaints of patients who visit emergency departments (ED). Many febrile patients have markedly elevated C-reactive protein (CRP) levels and normal white blood cell (WBC) counts. Most of these patients have bacterial infection and no previous underlying disease of impaired WBC functioning. We reviewed patients who visited our ED between November 2003 and July 2004. The WBC count and CRP level of patients over 18 years of age who visited the ED because of or with fever were recorded. Patients who had normal WBC count (4,000-10,000/L) and high CRP level (> 100 mg/L) were included. The data, including gender, age and length of hospital stay, were reviewed. Underlying diseases, diagnosis of the febrile disease and final condition were recorded according to the chart. Within the study period, 54,078 patients visited our ED. Of 5,628 febrile adults, 214 (3.8%) had elevated CRP level and normal WBC count. The major cause of febrility was infection (82.24%). Most of these patients were admitted (92.99%). There were 32 patients with malignant neoplasm, nine with liver cirrhosis, 66 with diabetes mellitus and 11 with uremia. There were no significant differences in age and gender between patients with and those without neoplasm. However, a higher inhospital mortality rate and other causes of febrility were noted in patients with neoplasm. It was not rare in febrile patients who visited the ED to have a high CRP level but normal WBC count. These patients did not necessarily have an underlying malignant neoplasm or hematologic illness. Factors other than malignant neoplasm or hematologic illness may be associated with the WBC response, and CRP may be a better indicator of infection under such conditions.
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PMID:Characteristics of febrile patients with normal white blood cell counts and high C-reactive protein levels in an emergency department. 1850 22

Plasma-based products are commonly used in patients who have chronic liver disease to treat perceived coagulopathy despite unproven efficacy and potentially severe risks, such as transfusion-related acute lung injury, which carries a high mortality rate. Moreover, volume expansion may acutely worsen portal hypertension and increase bleeding from the collateral portal vascular bed. Although factor replacement therapy may be warranted in selected situations, its use should be restricted because of the limitations of target tests, such as international normalized ratio, which poorly reflects presence of bleeding diatheses in patients who have cirrhosis. Renal replacement therapies are frequent adjuncts in patients who have cirrhosis and are acutely decompensated, and may correct uremia-related bleeding diathesis and assist in controlling vascular volume, although they are generally limited to use as a bridge to liver transplantation. Novel extracorporeal therapies are emerging and may also have significant interaction with the hemostatic system. Volume contraction and blood conservation therapies are relatively new and promising approaches to reduce use of blood products in liver transplantation.
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PMID:Blood products, volume control, and renal support in the coagulopathy of liver disease. 1915 Mar 12

Renal failure and the need for dialysis worsen the prognosis of patients with combined liver and kidney disease. The choice of an appropriate dialysis technique should improve the life expectancy of these patients. Hypotension, impaired defence against infections, electrolyte and acid-base imbalance, severe protein and caloric malnutrition, hyperammonemia, hyperbilirubinemia, and inadequate response to diuretics present a number of clinical problems in patients with liver insufficiency. Liver failure is therefore considered an important risk factor for any type of dialysis. Theoretically, both hemodialysis and peritoneal dialysis may cause specific problems in these patients. Hemodialysis has an increased cost/benefit ratio in cirrhotic patients. The administration of heparin during dialysis might worsen blood coagulation, ascites is not controlled by hemodialysis, and frequent paracentesis may be necessary. The efficiency of hemodialysis in removing certain toxic substances accumulating in liver failure is still unclear. Peritoneal dialysis does not require anticoagulation, helps maintain residual renal function, allows continuous removal of a fixed amount of ascitic fluid, does not cause acute hemodynamic changes, clears some of the toxic metabolites accumulated by liver failure, and is less expensive. Finally, peritoneal dialysis is associated with continuous absorption of glucose through the mesenteric capillaries into the mesenteric and liver blood flow, thus improving caloric malnutrition. During the first months of peritoneal dialysis, cirrhotic patients lose about 10 g of protein in the peritoneal dialysate but this loss tends to decrease with time. All the available data seem to indicate that in cirrhotic patients on peritoneal dialysis the majority of complications are consequent upon liver disease, which is also the most important cause of death. The outcome of peritoneal dialysis is not affected by cirrhosis and is similar to that observed in noncirrhotic patients. All the evidence reported in the literature seems to indicate that in cirrhotic patients peritoneal dialysis is an adequate treatment of uremia.
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PMID:[Peritoneal dialysis in cirrhotic patients]. 1938 77

Fournier gangrene is an acute and potentially fatal infection of the scrotum, perineum, and abdominal wall. It is characterized by necrotizing fasciitis with loss of subcutaneous tissue and skin. The aim of this study was to analyze the prognosis and treatment effectiveness of this fulminant infectious disease. Forty-one patients were admitted to our hospital with the diagnosis of Fournier gangrene between January 1998 and December 2006. The patients' age, sex, predisposing factors, duration of symptoms and hospital stay, time to operation, size of the skin defect, bacteria isolated, treatment modalities, and outcomes were reviewed. The data were analyzed by chi2 analysis and Student t test. A P-value <0.05 was considered significant. The mean age of the patients was 57.2 years. The most common predisposing factor was diabetes mellitus in 21 patients (51.2%), followed by cirrhosis of the liver, uremia, alcoholism, and underlying malignancy. The most common symptoms were fever (87.8%) and pain or swelling over the genital region (85.4%). The initial treatment included extensive debridement and open drainage. Time to operation ranged from 1 to 10 days. Reconstructive surgery was performed for 22 patients. The mortality rate was 19.5%. Delayed debridement was a significant factor affecting the survival rate. Our study is a retrospective study of patients with Fournier gangrene undergoing debridement and reconstructive procedure. Because of the fulminant course of Fournier gangrene, it may be difficult to design a prospective study. Fournier gangrene is a severe infectious disease with a high mortality rate. Early and aggressive debridement is a significant prognostic factor in the management of Fournier gangrene. Several reconstructive modalities are useful to correct the tissue defect. Early debridement and reconstructive surgery for wound coverage improve the quality of life.
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PMID:Fournier gangrene: a review of 41 patients and strategies for reconstruction. 2040 63


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