[Histological regression of liver fibrosis with immunosuppressive therapy in autoimmune hepatitis]. / Regresión histológica de la fibrosis hepática con tratamiento inmunosupresor en hepatitis autoinmune.

UNLABELLED: Reversibility of liver fibrosis with immunosuppressive therapy (IT) has been described in autoimmune hepatitis (AIH). OBJECTIVE: To compare initial fibrosis and fibrosis after IT in patients with AIH. METHODS: A total of 54 patients were admitted with positive ANA or AML antibodies, or both, elevated IgG immunoglobulins and who met international criteria for a diagnosis of AIH. The mean age was 39 years (range 13-65) and there were 47 women (87%). Two liver biopsies were taken: one at diagnosis and another at a mean of 28±8 months after initiation of IT with prednisone and azathioprine. The degree of inflammation (0-18) and fibrosis (0-6) according to Ishak score was compared between the initial and the follow-up biopsy. RESULTS: Fibrosis decreased from 2.9±0.3 to 2.2±0.3 (p=0.005) and histological activity index from 6.8±0.45 to 2.6±0.2 (P<.001). In subgroups, fibrosis decreased from 3.6±0.4 to 1.4±0.3 (P<.001) in 22 patients (41%), was unchanged in 27 (50%) and increased in five (9%). There were seven patients with histological cirrhosis at IT initiation. After IT, four showed a reduction in Ishak score (achieving scores of 0-3). Transaminase values were not associated with histological improvement. CONCLUSION: Fibrosis in patients with AIH significantly improved with IT, emphasizing the importance of studying the prognostic factors associated with this favorable response.

Regresión histológica de la fibrosis hepática con tratamiento inmunosupresor en hepatitis autoinmune / Histological regression of liver fibrosis with immunosuppressive therapy in autoimmune hepatitis

Resumen La reversibilidad de la fibrosis hepática se describe en hepatitis autoinmune(HAI) con tratamiento inmunosupresor (TI). Objetivo Comparar fibrosis inicial y con TI en HAI.MétodosIngresaron 54 pacientes con anticuerpos antinucleares y/o antimúsculo liso (+), IgG elevada y biopsia compatible, edad promedio 39 años (rango 13-65), 47 mujeres (87%), en tratamiento con prednisona y azatioprina. Se comparó grado de inflamación (0-18) y fibrosis (0-6) según score de Ishak entre biopsia inicial y control (prom 28±8 meses). Resultados La fibrosis disminuyó de 2,9±0,3 a 2,2±0,3 (p=0,005) y el índice de actividad histológica de 6,8±0,45 a 2,6±0,2 (p<0,001). En subgrupos esta disminuyó de 3,6±0,4 a 1,4±0,3 (p<0,001) en 22 pacientes (41%), no varió en 27 (50%) y aumentó en 5 (9%); 4/7 con cirrosis histológica inicial mejoraron a score 0-3 en control. La evolución de transaminasas no permitió predecir la mejoría histológica. Conclusión En pacientes con HAI el TI mejora significativamente la fibrosis, acentuando la importancia de estudiar factores pronósticos asociados a esta favorable respuesta (AU)

Abstract Reversibility of liver fibrosis with immunosuppressive therapy (IT) has been described in autoimmune hepatitis (AIH) Objective To compare initial fibrosis and fibrosis after IT in patients with AIH. Methods A total of 54 patients were admitted with positive ANA or AML antibodies, or both, elevated IgG immunoglobulins and who met international criteria for a diagnosis of AIH. The mean age was 39 years (range 13-65) and there were 47 women (87%). Two liver biopsies were taken: one at diagnosis and another at a mean of 28±8 months after initiation of IT with prednisone and azathioprine. The degree of inflammation (0-18) and fibrosis (0-6) according to Ishak score was compared between the initial and the follow-up biopsy. Results Fibrosis decreased from 2.9±0.3 to 2.2±0.3 (p=0.005) and histological activity index from 6.8±0.45 to 2.6±0.2 (P<.001). In subgroups, fibrosis decreased from 3.6±0.4 to 1.4±0.3 (P<.001) in 22 patients (41%), was unchanged in 27 (50%) and increased in five (9%). There were seven patients with histological cirrhosis at IT initiation. After IT, four showed a reduction in Ishak score (achieving scores of 0-3). Transaminase values were not associated with histological improvement. Conclusion Fibrosis in patients with AIH significantly improved with IT, emphasizing the importance of studying the prognostic factors associated with this favorable response (AU)

[Effects of acute octreotide infusion on renal function in patients with cirrhosis and portal hypertension]. / Efectos de la infusión aguda de octreotido sobre la función renal en pacientes con cirrosis hepática e hipertensión portal.

BACKGROUND: Octreotide is used in the treatment of acute variceal bleeding, based on its inhibitory effects of post-prandial splanchnic hyperemia and splanchnic venoconstriction. The consequences of these haemodynamic changes on renal circulation are not well known in cirrhotic patients. AIM: To evaluate the effects of acute octreotide administration on several parameters of renal function, including free water clearance, in patients with cirrhosis with or without ascites. PATIENTS AND METHODS: Twenty cirrhotic patients, Child-Pugh A orB, with or without ascites, with esophageal varices, normal renal function and free of medications (vasoactive drugs or diuretics) were assigned to 2 different protocols. Protocol 1: 10 patients were randomized to receive octreotide or placebo, as a bolus followed by a continuous infusion. Glomerular filtration rate (GFR) and renal plasma flow (PRF) were measured, in basal conditions and during the drug or placebo administration. Protocol 2: 10 additional patients were randomized in the same way and free water clearance and urinary sodium excretion were again measured in the basal period and during the drug or placebo infusion. RESULTS: After octreotide or placebo administration no significant changes were observed neither in GFR nor in PRF. The free water clearance decreased significantly during octreotide administration (3.12 ml/min+/-1.04 SE vs 0.88+/-0.39, p<.03). In both protocols no changes in mean arterial pressure were observed. CONCLUSIONS: Acute administration of octreotide to cirrhotic patients with portal hypertension, with or without ascites, did not produce any change in glomerular filtration rate or in estimated renal plasm blood flow. However the free water clearance decreased significantly. This effect, under chronic administration, could be clinically important and deserves further studies.

Efectos de la infusión aguda de octreotido sobre la función renal en pacientes con cirrosis hepática e hipertensión portal / Effects of acute octreotide infusion on renal function in patients with cirrhosis and portal hypertension

Background: Octreotide is used in the treatment of acute variceal bleeding, based on its inhibitory effects of post-prandial splanchnic hyperemia and splanchnic venoconstriction. The consequences of these haemodynamic changes on renal circulation are not well known in cirrhotic patients. Aim: To evaluate the effects of acute octreotide administration on several parameters of renal function, including free water clearance, in patients with cirrhosis with or without ascites. Patients and Methods: Twenty cirrhotic patients, Child-Pugh A or B, with or without ascites, with esophageal varices, normal renal function and free of medications (vasoactive drugs or diuretics) were assigned to 2 different protocols. Protocol 1: 10 patients were randomized to receive octreotide or placebo, as a bolus followed by a continuous infusion. Glomerular filtration rate (GFR) and renal plasma flow (PRF) were measured, in basal conditions and during the drug or placebo administration. Protocol 2: 10 additional patients were randomized in the same way and free water clearance and urinary sodium excretion were again measured in the basal period and during the drug or placebo infusion. Results: After octreotide or placebo administration no significant changes were observed neither in GFR nor in PRF. The free water clearance decreased significantly during octreotide administration (3.12 ml/min±1.04 SE vs 0.88±0.39, p <.03). In both protocols no changes in mean arterial pressure were observed. Conclusions: Acute administration of octreotide to cirrhotic patients with portal hypertension, with or without ascites, did not produce any change in glomerular filtration rate or in estimated renal plasma blood flow. However the free water clearance decreased significantly. This effect, under chronic administration, could be clinically important and deserves further studies.