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Hajjar SL, Magacha HM, Notta SN, Joseph D. Non-metastatic Nephrogenic Hepatic Dysfunction (Stauffer Syndrome) and Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) in a Patient With Renal Cell Carcinoma Coinciding With Liposarcoma. Cureus 2024; 16:e55714. [PMID: 38586650 PMCID: PMC10998433 DOI: 10.7759/cureus.55714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Stauffer syndrome is a non-metastatic, nephrogenic, hepatic dysfunction syndrome that is linked to extrahepatic paraneoplastic tumors. It manifests with varying clinical signs that include jaundice, anicteric transaminitis, elevated alkaline phosphatase, thrombocytosis, elevated erythrocyte sedimentation rate, prolonged prothrombin time, and, in some cases, hepatosplenomegaly in the absence of hepatobiliary obstruction. Stauffer syndrome is mostly associated with renal cell carcinoma, but research shows other solid malignancies are implicated with this syndrome. Stauffer syndrome is characterized by elevated liver function tests, specifically those that indicate the presence of cholestasis with or without hepatosplenomegaly. The abnormality is not due to tumor infiltration but rather indirect paraneoplastic effects that are poorly understood. Additionally, emerging literature also supports the association of syndrome of inappropriate antidiuretic hormone secretion (SIADH) secondary to malignancy in the setting of elevated interleukin-6. In this article, we present the case of a 76-year-old patient with SIADH and abnormalities in liver function tests in the context of Stauffer syndrome tied to renal cell carcinoma coinciding with liposarcoma.
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Affiliation(s)
- Sabahuddin L Hajjar
- Internal Medicine, East Tennessee State University James H. Quillen College of Medicine, Johnson City, USA
| | - Hezborn M Magacha
- Internal Medicine, East Tennessee State University, Johnson City, USA
| | - Shahnawaz N Notta
- Internal Medicine, East Tennessee State University James H. Quillen College of Medicine, Johnson City, USA
| | - David Joseph
- Nephrology, Veterans Affairs Medical Center, Mountain Home, Johnson City, USA
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Contemporary Clinical Definitions, Differential Diagnosis, and Novel Predictive Tools for Renal Cell Carcinoma. Biomedicines 2022; 10:biomedicines10112926. [PMID: 36428491 PMCID: PMC9687297 DOI: 10.3390/biomedicines10112926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/26/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
Despite significant progress regarding clinical detection/imaging evaluation modalities and genetic/molecular characterization of pathogenesis, advanced renal cell carcinoma (RCC) remains an incurable disease and overall RCC mortality has been steadily rising for decades. Concomitantly, clinical definitions have been greatly nuanced and refined. RCCs are currently viewed as a heterogeneous series of cancers, with the same anatomical origin, but fundamentally different metabolisms and clinical behaviors. Thus, RCC pathological diagnosis/subtyping guidelines have become increasingly intricate and cumbersome, routinely requiring ancillary studies, mainly immunohistochemistry. Meanwhile, RCC-associated-antigen targeted systemic therapy has been greatly diversified and emerging, novel clinical applications for RCC immunotherapy have already reported significant survival benefits, at least in the adjuvant setting. Even so, systemically disseminated RCCs still associate very poor clinical outcomes, with currently available therapeutic modalities only being able to prolong survival. In lack of a definitive cure for advanced RCCs, integration of the amounting scientific knowledge regarding RCC pathogenesis into RCC clinical management has been paramount for improving patient outcomes. The current review aims to offer an integrative perspective regarding contemporary RCC clinical definitions, proper RCC clinical work-up at initial diagnosis (semiology and multimodal imaging), RCC pathological evaluation, differential diagnosis/subtyping protocols, and novel clinical tools for RCC screening, risk stratification and therapeutic response prediction.
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Kamimura H, Iwasaki T, Hayashi K, Terai S. Rare paraneoplastic syndromes in digestive systems caused by lung cancer. BMJ Case Rep 2021; 14:14/2/e240161. [PMID: 33547104 PMCID: PMC7871262 DOI: 10.1136/bcr-2020-240161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We observed a rare case of two different digestive paraneoplastic syndromes that improved with the treatment of the neoplasms. The first syndrome was chronic intestinal pseudo-obstruction (CIPO), which is a subtype of paraneoplastic syndromes called a paraneoplastic neurological syndrome (PNS). The second was Stauffer's syndrome, which is a unique paraneoplastic syndrome characterised by non-metastatic intrahepatic cholestasis associated with neoplasms. Here, we report the case of a 55-year-old man who presented with two concurrent paraneoplastic syndromes in the digestive system. The intestinal pseudo-obstruction and elevated biliary enzyme levels improved as the lung cancer responded to chemotherapy. In this case, CIPO as a PNS led to the detection of lung cancer. To our knowledge, this is the first report of Stauffer's syndrome caused by lung adenocarcinoma.
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Affiliation(s)
- Hiroteru Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences Niigata University, Niigata, Japan
| | | | - Kazunao Hayashi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences Niigata University, Niigata, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences Niigata University, Niigata, Japan
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Cholestatic Hepatitis as a Possible Paraneoplastic Syndrome of Endometrial Carcinoma. ACG Case Rep J 2020; 7:e00350. [PMID: 32337313 PMCID: PMC7162118 DOI: 10.14309/crj.0000000000000350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 01/29/2020] [Indexed: 11/17/2022] Open
Abstract
Cholestatic hepatitis has not been reported as a paraneoplastic syndrome of endometrial adenocarcinoma to our knowledge. We present a patient who, shortly after endometrial adenocarcinoma diagnosis, presented with elevated liver chemistries in the setting of an acute, paraneoplastic sensorimotor polyneuropathy. Infectious, autoimmune, pharmacologic, malignant, metabolic, and structural causes of cholestatic hepatitis were screened for and ruled out. Our patient was diagnosed with simultaneous cholestatic hepatitis and acute sensorimotor polyneuropathy as possible paraneoplastic syndromes of endometrial adenocarcinoma. Clinicians should include paraneoplastic processes of cancer in the differential diagnosis for liver injury, especially when workup for alternative causes is unrevealing.
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Liu J, Agyapong G, Misra D, Taylor CD, Hirsh DA. A rare case of idiopathic cholestasis: Clinical conundrums complicating enzalutamide therapy in metastatic prostate cancer. Clin Case Rep 2019; 7:2068-2073. [PMID: 31788253 PMCID: PMC6878062 DOI: 10.1002/ccr3.2427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 08/26/2019] [Accepted: 09/01/2019] [Indexed: 12/27/2022] Open
Abstract
Current safety data affirms enzalutamide does not cause clinically significant liver dysfunction that warrant therapy cessation. Therefore, clinicians should not withhold potentially successful therapy merely for suspected hepatotoxicity or PnC.
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Affiliation(s)
- Jun Liu
- Harvard Medical SchoolBostonMAUSA
| | | | - Debashish Misra
- Harvard Medical SchoolBostonMAUSA
- Department of MedicineCambridge Health AllianceCambridgeMAUSA
| | - C. Douglas Taylor
- Harvard Medical SchoolBostonMAUSA
- Department of MedicineCambridge Health AllianceCambridgeMAUSA
| | - David A. Hirsh
- Harvard Medical SchoolBostonMAUSA
- Department of MedicineCambridge Health AllianceCambridgeMAUSA
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Stauffer's Syndrome in Patient with Metastatic Prostate Cancer. Case Rep Urol 2019; 2019:9745301. [PMID: 31179152 PMCID: PMC6501217 DOI: 10.1155/2019/9745301] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/11/2019] [Indexed: 11/18/2022] Open
Abstract
Cholestasis is a symptom that can be present in many conditions, such as bile duct obstruction by malignant mases, obstruction by gallstone, acute and chronic viral hepatitis, and autoimmune disorders, such as primary biliary and sclerosing cholangitis. Stauffer syndrome is a rare type of paraneoplastic syndrome that presents as cholestasis with absence of underlying disease. Classically Stauffer syndrome has been described in renal cell cancer patients. In literature cholestasis as manifestation of paraneoplastic syndrome has also been described in patients with prostate adenocarcinoma and pancreatic and bronchogenic carcinoma. Conclusions. Stauffer syndrome should be kept in mind in patients who present with cholestasis with no underlying cause. We advise to exclude any possible causes of cholestasis, for example, obstruction of bile duct.
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Fonseka CL, Kariyawasam AGTA, Singhapura SAGL, de Silva CM, Kanakkahewa TE, Senarathna IGTM, Bodinayake CK. Metastatic Renal Cell Carcinoma Presenting as Prolonged Pyrexia and Stauffer's Syndrome: Can a Routine Ultrasound Scan Fail to Detect a Renal Cell Carcinoma? Case Rep Radiol 2018; 2018:4215041. [PMID: 30057844 PMCID: PMC6051266 DOI: 10.1155/2018/4215041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/13/2018] [Indexed: 11/18/2022] Open
Abstract
Background Prolonged pyrexia and weight loss are recognised paraneoplastic manifestations of renal cell carcinoma (RCC). Stauffer's syndrome is a rarely described paraneoplastic manifestation, which is described early in the course of RCC. We report a patient who presented with unresolving fever with multiple pulmonary opacities with biochemical evidence of hepatic choleastasis and was later diagnosed to have metastatic RCC with Stauffer's syndrome. Case Presentation We report a 54-year-old female who was investigated for a poorly resolving fever and recent weight loss for two months. During her course of illness, she developed bilateral multiple opacifications in the chest radiograph with negative pyogenic, mycobacterial microbiological studies. Despite intravenous antibiotics, her fever continued. She was found to have elevated alkaline phosphatase and gamma-glutamyl transferase and she underwent imaging with ultrasound scan of abdomen twice, which did not reveal demonstrable abnormalities. Later, contrast CT of abdomen and chest was performed and detected a renal cell carcinoma of the right upper pole of the kidney with multiple lung metastases, which was concluded as a metastatic RCC with paraneoplastic Stauffer's syndrome. Conclusion Prolonged pyrexia with loss of weight and Stauffer's syndrome could be features to suggest renal cell carcinoma in the absence of positive microbiological studies. Isoechoic RCC could be missed in routine ultrasonography. When a RCC is suspected in the setting of a pyrexia of unknown origin, ultrasound with doppler or a contrast CT should be requested to aid diagnosis.
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Affiliation(s)
- C. L. Fonseka
- University Medical Unit, Teaching Hospital Karapitiya, Galle, Sri Lanka
- Department of Internal Medicine, Faculty of Medicine, University of Ruhuna, Sri Lanka
| | | | | | - C. M. de Silva
- Department of Internal Medicine, Faculty of Medicine, University of Ruhuna, Sri Lanka
| | - T. E. Kanakkahewa
- Department of Internal Medicine, Faculty of Medicine, University of Ruhuna, Sri Lanka
| | | | - C. K. Bodinayake
- University Medical Unit, Teaching Hospital Karapitiya, Galle, Sri Lanka
- Department of Internal Medicine, Faculty of Medicine, University of Ruhuna, Sri Lanka
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Fontes-Sousa M, Magalhães H, da Silva FC, Maurício MJ. Stauffer's syndrome: A comprehensive review and proposed updated diagnostic criteria. Urol Oncol 2018; 36:321-326. [PMID: 29657090 DOI: 10.1016/j.urolonc.2018.01.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/07/2017] [Accepted: 01/28/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Stauffer's syndrome corresponds to a set of clinical and analytical changes of paraneoplastic nature firstly recognized more than 50 years ago, in association to renal cell carcinoma. A definitive review including universal diagnostic criteria and updated knowledge since the original description is lacking. BASIC PROCEDURES The authors conducted a comprehensive bibliographical review and propose updated diagnostic criteria to standardize diagnosis for clinical practice purposes and avoid misclassification. MAIN FINDINGS Although having been described in association with renal cell carcinoma, the syndrome has been reported in correlation with other malignancies-either solid or hematological tumors. Additionally, a variant syndrome presenting with jaundice has also been characterized, but appears to have a similar clinical course to that of the classical Stauffer's syndrome. Although often described as rare, it may be more frequent than previously recognized. Stauffer's syndrome etiopathogenesis is still poorly understood, but immune mechanisms seem to play a role underscored by the malignancies to which the syndrome is associated, several of which having immunotherapy drugs approved for their treatment. PRINCIPAL CONCLUSIONS A set of diagnostic criteria should be used to simplify, broaden and standardized diagnosis, under the entity characterized by reversible paraneoplastic intrahepatic cholestasis. Clinicians should be aware of the syndrome, namely consider further investigation if a plausible cause for unexplained intrahepatic cholestasis in an otherwise healthy patient is not found. Even though no universal approach is available, investigation should be considered regarding metastatic disease after resection of a primary tumor which has revealed persistence or recurrence of symptoms.
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Affiliation(s)
- Mário Fontes-Sousa
- Department of Medical Oncology, Portuguese Oncology Institute of Porto, Porto, Portugal; Portuguese Genitourinary Group (GPGU), Lisbon, Portugal.
| | - Helena Magalhães
- Department of Medical Oncology, Portuguese Oncology Institute of Porto, Porto, Portugal; Portuguese Genitourinary Group (GPGU), Lisbon, Portugal
| | | | - Maria Joaquina Maurício
- Department of Medical Oncology, Portuguese Oncology Institute of Porto, Porto, Portugal; Portuguese Genitourinary Group (GPGU), Lisbon, Portugal
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Paraneoplastic Hepatopathy Associated with Gastrointestinal Carcinoid. ACG Case Rep J 2017; 4:e117. [PMID: 29138755 PMCID: PMC5679777 DOI: 10.14309/crj.2017.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/21/2017] [Indexed: 11/17/2022] Open
Abstract
Paraneoplastic hepatopathy has been reported with various malignancies, most commonly with renal cell cancer. This non-metastatic hepatic dysfunction in such malignancies is known as Stauffer syndrome. We describe a 61-year-old man who presented with symptoms of bowel obstruction with marked cholestasis and high levels of alkaline phosphatase and bilirubin. Imaging revealed an unremarkable liver and a mass in the ileocecal valve with mesenteric lymphadenopathy. Biopsies were consistent with a carcinoid tumor. Liver dysfunction gradually resolved after surgical resection of the tumor. Paraneoplastic syndrome should be considered in the differential diagnosis for patients with carcinoid tumors who present with cholestasis.
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Gremida A, Al-Taee A, Alcorn J, McCarthy D. Hepatic Dysfunction in Renal Cell Carcinoma: Not What You Think? Dig Dis Sci 2017; 62:2298-2302. [PMID: 28785916 DOI: 10.1007/s10620-017-4706-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Anas Gremida
- Division of Gastroenterology, University of New Mexico School of Medicine, Albuquerque, NM, USA. .,Division of Gastroenterology and Hepatology, University of New Mexico, MSC 10-5550, Albuquerque, NM, 87131, USA.
| | - Ahmad Al-Taee
- Department of Internal Medicine, Saint Louis University, Saint Louis, MO, USA
| | - Joseph Alcorn
- Division of Gastroenterology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Denis McCarthy
- Division of Gastroenterology, University of New Mexico School of Medicine, Albuquerque, NM, USA
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The ketogenic diet is not feasible as a therapy in a CD-1 nu/nu mouse model of renal cell carcinoma with features of Stauffer's syndrome. Oncotarget 2017; 8:57201-57215. [PMID: 28915665 PMCID: PMC5593636 DOI: 10.18632/oncotarget.19306] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/27/2017] [Indexed: 12/29/2022] Open
Abstract
The ketogenic diet (KD), a high-fat low-carbohydrate diet, has shown some efficacy in the treatment of certain types of tumors such as brain tumors and neuroblastoma. These tumors are characterized by the Warburg effect. Because renal cell carcinoma (RCC) presents similar energetic features as neuroblastoma, KD might also be effective in the treatment of RCC. To test this, we established xenografts with RCC 786-O cells in CD-1 nu/nu mice and then randomized them to a control diet or to KDs with different triglyceride contents. Although the KDs tended to reduce tumor growth, mouse survival was dramatically reduced due to massive weight loss. A possible explanation comes from observations of human RCC patients, who often experience secondary non-metastatic hepatic dysfunction due to secretion of high levels of inflammatory cytokines by the RCCs. Measurement of the mRNA levels of tumor necrosis factor alpha (TNFα) and interleukin-6 revealed high expression in the RCC xenografts compared to the original 786-O cells. The expression of TNFα, interleukin-6 and C-reactive protein were all increased in the livers of tumor-bearing mice, and KD significantly boosted their expression. KDs did not cause weight loss or liver inflammation in healthy mice, suggesting that KDs are per se safe, but might be contraindicated in the treatment of RCC patients presenting with Stauffer's syndrome, because they potentially worsen the associated hepatic dysfunction.
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Abstract
Stauffer's syndrome is a rare paraneoplastic syndrome classically associated with renal cell carcinoma. It presents as abnormal hepatic panel in the absence of hepatic disease, which improves with treatment of the cancer and worsens with recurrence. Here, we describe a case of hepatic panel abnormalities in a patient with pancreatic cancer with no evidence of metastatic disease to the liver, primary hepatobiliary etiology, or clear offending medications. We believe this to be the first reported case of Stauffer's syndrome in patients with pancreatic cancer.
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Ferraz de Campos FP, Narvaez MRA, Reis PVS, Gomes ACM, Paraskevopoulos DKDS, Santana F, Fugita OEH. Acanthosis Nigricans associated with clear-cell renal cell carcinoma. AUTOPSY AND CASE REPORTS 2016; 6:33-40. [PMID: 27284539 PMCID: PMC4880432 DOI: 10.4322/acr.2016.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/31/2016] [Indexed: 12/29/2022] Open
Abstract
Acanthosis nigricans (AN), an entity recognized since the 19th century, is a dermatopathy associated with insulin-resistant conditions, endocrinopathies, drugs, chromosome abnormalities and neoplasia. The latter, also known as malignant AN, is mostly related to abdominal neoplasms. Malignant AN occurs frequently among elderly patients. In these cases, the onset is subtle, and spreading involves the flexural regions of the body, particularly the axillae, palms, soles, and mucosa. Gastric adenocarcinoma is the most frequent associated neoplasia, but many others have been reported. Renal cell carcinoma (RCC), although already reported, is rarely associated with malignant AN. The authors report the case of a woman who was being treated for depression but presented a long-standing and marked weight loss, followed by darkening of the neck and the axillary regions. Physical examination disclosed a tumoral mass in the left flank and symmetrical, pigmented, velvety, verrucous plaques on both axillae, which is classical for AN. The diagnostic work-up disclosed a huge renal mass, which was resected and further diagnosed as a RCC. The post-operative period was uneventful and the skin alteration was evanescent at the first follow-up consultation. The authors call attention to the association of AN with RCC.
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Affiliation(s)
| | | | | | | | | | - Frederico Santana
- Pathology Department - Faculty of Medicine - University of São Paulo, São Paulo/SP - Brazil
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A Stauffer's syndrome variant associated with renal cell carcinoma and thrombocytopenia. AFRICAN JOURNAL OF UROLOGY 2015. [DOI: 10.1016/j.afju.2015.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Prothrombin complex concentrate (Octaplex®) for postsurgical bleeding control in a Stauffer's syndrome. Ann Hematol 2012; 91:1325-6. [PMID: 22258327 DOI: 10.1007/s00277-011-1396-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 12/28/2011] [Indexed: 10/14/2022]
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Abstract
Many liver diseases coexist with chronic renal disease, because many systemic conditions affect both the liver and the kidneys. Certain liver diseases are also common in patients with chronic renal disease, especially viral hepatitis, either because the renal disease occurs as a complication of viral hepatitis, or the viral hepatitis is acquired as a result of dialysis. Renal tubular dysfunction is also frequently observed with cholestasis. However, liver complications of renal diseases are extremely uncommon, notable examples include nephrogenic ascites and nephrogenic hepatic dysfunction. Nephrogenic ascites can mimic liver cirrhosis with ascites, and it improves with renal transplantation. Nephrogenic hepatic dysfunction is a manifestation of renal cell carcinoma, which settles with the removal of the renal cell carcinoma, but returns with the recurrence of the tumor. In general, the presence of liver disease in patients with chronic renal disease makes management of both conditions more challenging. Viral hepatitis should be treated, if possible, before renal transplant. If cirrhosis is present, renal transplant alone is contraindicated; combined liver and kidney transplantation is indicated in patients with end-stage renal disease and advanced cirrhosis.
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Affiliation(s)
- Florence Wong
- Department of Medicine, Toronto General Hospital, University of Toronto, 9th floor, North Wing, Room 983, 200 Elizabeth Street, Toronto M5G 2C4, Ontario, Canada.
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Nguyen V, Gurney H, van der Poorten D. Paraneoplastic Hepatic Dysfunction in Metastatic Prostate Cancer: The Role of Cytokine Dysregulation. J Clin Oncol 2011; 29:e21-3. [DOI: 10.1200/jco.2010.30.6522] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Vi Nguyen
- Westmead Hospital, Sydney, New South Wales, Australia
| | - Howard Gurney
- Westmead Hospital, Sydney, New South Wales, Australia
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Behnava B, Alavian SM. A woman with recent jaundice and pruritus. HEPATITIS MONTHLY 2010; 10:48-52. [PMID: 22308126 PMCID: PMC3270345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 12/01/2009] [Accepted: 01/03/2010] [Indexed: 11/05/2022]
Abstract
A middle-aged woman suffering from jaundice and pruritus that had begun a month previously was presented to a physician.At the first assessment, laboratory findings had revealed a cholestatic pattern and serologic tests for hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis A virus (HAV) were negative. Normal findings of abdominal computed tomography (CT) scan and endoscopic retrograde cholangiopancreatography (ERCP) ruled out extrahepatic causes of cholestasis. A liver biopsy was done and showed intrahepatic cholestasis without destruction of the bile ducts or granuloma.We assessed the intrahepatic causes of cholestasis. Finally the diagnosis was confirmed by means of a simple test.
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Affiliation(s)
- Bita Behnava
- Baqiyatallah Research Center for Gastroenterology and Liver Disease,Baqiyatallah University of Medical Sciences, Tehran, I.R.Iran,Corresponding author at: Bita Behnava, M. D., Baqiyatallah Research Center for Gastroenterology and Liver Disease, Baqiyatallah University of Medical Sciences, Tehran, I.R.Iran. Tel.: +98 21 8126 2072, Fax: +98 21 8126 2072, E-mail:
| | - Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Disease,Baqiyatallah University of Medical Sciences, Tehran, I.R.Iran
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