ABSTRACT
Hepatorenal syndrome (HRS) is a life-treating complication of liver diseases. This functional kidney impairment is classified into acute (type I) and chronic (type II) types and is connected with high mortality. Treatment options are limited, but administration of vasoconstrictors (terlipressin), albumin and portosystemic shunt may improve their prognosis. Liver transplantation is the most effective method for these patients. Authors want to present recent data relating to HRS, including therapeutic recommendations.
Subject(s)
Hepatorenal Syndrome/therapy , Hepatorenal Syndrome/diagnosis , Hepatorenal Syndrome/physiopathology , Humans , Liver Transplantation , Lypressin/analogs & derivatives , Lypressin/therapeutic use , Portasystemic Shunt, Surgical , Prognosis , Terlipressin , Vasoconstrictor Agents/therapeutic useABSTRACT
Hypocholesterolemia is commonly found in critically ill patients; however, the aetiology of this condition remains unclear. Several clinical studies refer to the possible negative impact of haemodilution on cholesterol (CH) metabolism in acute medical conditions. The aim of this study was to examine the serum CH profile (total CH, LDL and HDL CH) during acute gastrointestinal bleeding which is a life-threatening condition characterised by alterations in lipid metabolism. Serum non-CH sterols (lathosterol, squalene, sitosterol and campesterol) concentrations as markers of CH synthesis and CH absorption were measured at the same time. Twenty-four patients with acute upper gastrointestinal bleeding (UGIB) were measured for these parameters over a 6-day period. The control group was 100 healthy blood donors.We found lower plasma levels of total CH (p < 0.001) and LDL CH (p < 0.05) in patients with UGIB than in the control group. The decreased HDL CH plasma levels in patients were not statistically significant. In addition, patients had significantly lower plasma levels of lathosterol, squalene, campesterol and sitosterol (p < 0.05).Our results showed abnormalities not only in the CH plasma profile, but also in plasma concentrations of non-CH sterols. These findings of alterations in both the CH synthesis and absorption process could be a contributory cause of hypocholesterolemia during acute gastrointestinal bleeding. However, further research is necessary.
Subject(s)
Cholesterol/blood , Gastrointestinal Hemorrhage/blood , Hypercholesterolemia/blood , Acute Disease , Aged , Cholesterol, HDL/blood , Cholesterol, LDL/blood , Cohort Studies , Combined Modality Therapy , Endoscopy, Gastrointestinal , Erythrocyte Transfusion , Esophageal and Gastric Varices/blood , Esophageal and Gastric Varices/etiology , Esophageal and Gastric Varices/therapy , Female , Fluid Therapy , Follow-Up Studies , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Hematemesis/blood , Hematemesis/therapy , Hemodilution/adverse effects , Humans , Infusions, Intravenous , Intensive Care Units , Liver Cirrhosis/blood , Liver Cirrhosis/complications , Liver Cirrhosis/therapy , Lypressin/administration & dosage , Lypressin/analogs & derivatives , Male , Melena/blood , Melena/therapy , Middle Aged , Omeprazole/administration & dosage , Parenteral Nutrition, Total , Proton Pump Inhibitors/administration & dosage , TerlipressinABSTRACT
Hypocholesterolemia has been investigated as a typical feature of critical illness and is connected with poor prognosis. Crohn's disease is an inflammatory process and is associated with several metabolic disturbances. In recent decades clinical studies have established a link between lipid metabolism and systemic inflammation. In our study we examined the serum profile of cholesterol (total cholesterol, LDL- and HDL-cholesterol) and changes in the cholesterol absorption/synthesis process by determination of plasma non-cholesterol sterol (squalene, lathosterol, campesterol, sitosterol) concentrations. Serum concentrations of total cholesterol, LDL- and HDL-cholesterol and non-cholesterol sterols were evaluated in 24 patients with active Crohn's disease during a period of 28 days. We detected lower serum levels of total cholesterol (P < 0.001), LDL- and HDL-cholesterol (P < 0.05) in the patients with active Crohn's disease than in the control group. In addition, the patients had significantly lower plasma levels of lathosterol (P < 0.001) and higher concentrations of squalene, although without significant differences. A significant decrease of campesterol plasma levels (P < 0.001) was detected, but lower plasma concentrations of sitosterol were without statistical significance. The active phase of Crohn's disease is characterized by altered metabolism of lipids, mainly of cholesterol. Our results show abnormalities in plasma concentrations of non-cholesterol sterols and provide evidence that the process of cholesterol synthesis and absorption is altered in active Crohn's disease.
