Background: Kidney dysfunction is a common complication in patients with severe liver cirrhosis. There is a need for discovery and validation of novel biomarkers for earlier AKI detection. The aim of this study was to determine if tubular injury markers: NGAL and KIM-1 could be helpful in the early diagnosis of AKI in patients undergoing therapeutic paracentesis. Methods: This preliminary study included 24 adult patients diagnosed with liver cirrhosis who had been hospitalized due to massive ascites requiring paracentesis. Pre-and post-paracentesis plasma samples were taken from each patient and biomarkers were measured. Results: Before paracentesis, the levels of serum and urinary NGAL were similar between patients and controls; while urinary KIM-1 was markedly increased in liver cirrhotic patients (0.76 vs. 0.24 ng/ml; respectively). Although urinary NGAL levels in AKI patients were 5-time greater than in non-AKI subgroup, the difference did not reach statistical significance (13.2 vs 1.5 pg/mL, p ¼ 0.06). Serum NGAL level, post-procedure, was 3 times greater in AKI subgroup. Conclusion: Kidney injury markers, especially serum NGAL, may be useful for the early detection of AKI. However, further research is required to determine if biomarkers of kidney injury may help identify patients with cirrhosis who would most likely benefit from early AKI prevention and treatment.
Cardiac amyloidosis (CA) is a rare systemic disease determined by the extracellular deposition of amyloid protein in the heart. The protein can accumulate in any part of the heart: myocardium, vessels, endocardium, valves, epicardium and parietal pericardium. The types of CA include the following types: light chain (AL), amyloidosis AA (Amyloid A) and transthyretin (ATTR). The detection of specific subtypes remains of great importance to implement the targeted treatment. We present the case of a 65-year-old woman, who was admitted with severe deterioration of exercise capacity, a bilateral reduction of physiological vesicular murmur, ascites and edema of lower extremities. CA was suspected due to echocardiographic examination results, which led to further examination and final diagnosis. The aim of this study is to improve the disease awareness among clinicians and shorten the delay between the first symptoms and the diagnosis establishment resulting in a better outcome.
Introduction Zonulin is a protein that reversibly modulates the permeability of tight junction of the small intestine wall. As the serum concentration of “zonulin family peptides” (ZFPs) is considered to be a sensitive and useful marker of intestinal wall permeability, its serum level may affect the volume of ascites fluid and change in gut microbiota. The aim of the study was to assess the association between concentrations of ZFPs in serum and ascites in relation to the severity of liver cirrhosis. Methods The preliminary study included 24 adult patients diagnosed with alcoholic or viral liver cirrhosis. 18 healthy adult subjects were enrolled as the control group. In patients and controls, there were measured serum and ascites (only in patients) ZFPs, serum bilirubin, creatinine, alanine aminotransferase, total protein, and C-reactive protein (CRP). Results Cirrhotic patients had lower serum hemoglobin (11.6 vs. 14.3 mg/dL; p < 0.001), platelet count (178 vs. 305 × 103/mm3; p < 0.01), total protein and albumin (58.6 vs. 74.3 g/dL; p < 0.001, 26.6 vs. 42.3 g/dL; p < 0.001, respectively), and serum ZFPs (30.5 vs. 62.0 ng/mL; p < 0.001) in comparison to controls. In patients with cirrhosis serum bilirubin, C-reactive protein level and INR were higher than in controls (3.07 vs. 0.96 mg/dL; 36.9 vs. 5 mg/L; 1.53 vs. 0.95; p < 0.001, respectively). Patients with low ZFP levels were characterized with lower ascites ZFP levels (0.25 vs. 16.4 ng/mL; p < 0.001) and ascites/serum index (0.011 vs. 0.462; p < 0.001). There were negative correlations between ascites ZFPs and platelet count (R = −0.497; p < 0.01) and positive correlation with INR (R = 0.640; p < 0.001). ZFP index positively correlated with platelet count (R = 0.726; p < 0.001) and negatively with INR (R = −0.392; p = 0.06). Conclusions Decrease serum ZFP levels seem to reflect their decreased liver synthesis but not increased gut permeability in patients with liver cirrhosis. The physiologically low level of ZFPs in transudate is increased in exudate.
Acute adrenal insufficiency is a clinical syndrome caused by a sudden and significant cortisol deficiency, which is life-threatening. Quite frequently, the diagnosis of this disease entity in subjects with normal secretory function is a challenge for clinicians. We present a female patient with bilateral adrenal haemorrhage secondary to type 2 heparin-induced thrombocytopaenia.This 71-year-old patient after the procedure of right knee arthroplasty conducted 8 days before, with ongoing anticoagulant prophylaxis with enoxaparin (40 mg/d), was admitted to the emergency department (ED) due to abdominal pain (score 9/10). Her medical history revealed treatment due to hypertension and type 2 diabetes. Physical and laboratory tests showed no clinically significant abnormalities. A chest X-ray showed a dilated aortic arch with atherosclerotic lesions, and an abdominal ultrasound revealed hepatic steatosis and atherosclerosis of abdominal aorta. After symptomatic treatment, the patient was discharged home. On the next day, the patient was readmitted to the ED due to deterioration of contact and recurrence of abdominal pain. Laboratory tests showed a gradual increase in leucocytosis and concentration of C-reactive protein (CRP), the presence of thrombocytopaenia and acute severe hyponatraemia, and a relatively mild hyperglycaemia (Tab. 1). The patient had a CT scan of the aorta with contrast, which showed no pathology of the aorta or its branches, except for atherosclerosis, but which showed bilateral enlargement of the adrenal glands, up to 3 cm, surrounded by densities -status post haemorrhage (Fig. 1A). Hormonal diagnostics showed a very low level of blood
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