A Case of Concomitant Multiple Myeloma and Cirrhosis

A 66-year-old Caucasian female with a recent history of COVID-19 (about one month prior to the current admission) and cirrhosis, presented with acute kidney injury (AKI) and worsening encephalopathy. Initial management focused on addressing her AKI, initially suspected to be secondary to volume depletion or hepatorenal syndrome (HRS) and confusion from hepatic encephalopathy. However, further evaluation unveiled a persistent serum protein gap, hypercalcemia, and significant non-albumin proteinuria, prompting a more comprehensive diagnostic approach. Subsequent investigations revealed a high serum free light chain ratio, positive serum protein electrophoresis, and monoclonal gammopathy, indicative of a plasma cell disorder. A bone survey did not indicate aggressive bone lesions, but a bone marrow biopsy confirmed multiple myeloma with approximately 10% kappa light chain-restricted plasma cells. Despite appropriate treatment, the patient's health continued to decline, and the patient was subsequently transitioned to comfort care. While the relationship between cirrhosis and multiple myeloma remains to be fully understood, our case report explores four potential explanations: coincidental coexistence, cirrhosis as a risk factor for multiple myeloma, multiple myeloma as a risk factor for cirrhosis, or a shared predisposing condition.

SIRT1/Nrf2/NF-κB Signaling Mediates Anti-Inflammatory and Anti-Apoptotic Activities of Oleanolic Acid in a Mouse Model of Acute Hepatorenal Damage

Background and objectives: Oleanolic acid (OA) is a penta-cyclic triterpene with diverse bioactivities such as anticarcinogenic, antiviral, antimicrobial, hepatoprotective, anti-atherosclerotic, hypolipidemic, and gastroprotective. However, its effects on hepatorenal damage remain unclear. The protective activity of OA, separated from Viscum schimperi (Loranthaceae), against TAA (thioacetamide)-produced acute hepatic and renal damage was explored. Materials and Methods: Mice were treated with OA for 7 days before TAA (200 mg/kg, i.p.). Serum indices of hepatorenal injury, pathological lesions, molecular biological indexes, and inflammatory/apoptotic genes were estimated. Results: The tissues of both organs were greatly affected by the TAA injection. That was evident through increased serum markers of hepato-renal injury as well as remarkable histopathological lesions. TAA-induced injury was associated with oxidative and inflammatory responses in both organs as there was an elevation of oxidative stress parameters (4-HNE (4-hydroxy-nonenal), MDA (malondialdehyde), NOx (nitric oxide)), decline of antioxidants (reduced glutathione (GSH), superoxide dismutase (SOD), and total antioxidant capacity (TAC)), and an increase in the gene expression/level of inflammatory mediators (interleukins (1β&6)). The inflammatory response was linked to a significant activation of NF-κB (nuclear-factor kappa-B)/TNF-α (tumor-necrosis factor-alpha) signaling. The inflammatory response in both organs was accompanied by apoptotic changes, including a rise in the gene expression and level of apoptotic parameters (caspase-3 and Bax) along with a decline in Bcl-2 (anti-apoptotic parameter) gene expression and level. These pathogenic events were found to be closely related to the suppression of the antioxidant signaling pathway, Nrf2 (nuclear-factor erythroid 2-related factor-2)/SIRT1 (sirtuin-1)/HO-1 (heme-oxygenase 1). On the other hand, OA significantly ameliorated TAA-induced injury in both organs. On the other hand, OA counterpoised the inflammatory response as it ameliorated NF-κB/TNF-α signaling and cytokine release. OA enhanced Nrf2/SIRT1/HO-1 signaling and counteracted apoptotic damage. Conclusions: OA showed anti-inflammation and antiapoptotic capacities that effectively suppressed TAA-induced acute hepatorenal damage.

Apigenin protects from hepatorenal damage caused by lead acetate in rats

Exposure to lead (Pb) is associated with serious health problems including hepatorenal toxicity. Apigenin is a natural-sourced flavonoid with promising antioxidant and anti-inflammatory effects. In this research, we investigated the potential protective role of apigenin against lead acetate (PbAc)-induced hepatorenal damage. Thus, this experiment studied the exposure of male Wistar Albino rats to apigenin and/or PbAc and their effects in comparison to the control rats. Apigenin administration decreased the levels of Pb and prevented the histopathological deformations in liver and kidney tissues following PbAc exposure. This was confirmed by the normalized levels of liver and kidney function markers. Additionally, apigenin inhibited significantly oxidative reactions through upregulating Nrf2 and HO-1, and activating their downstreamed antioxidants accompanied by a marked depletion of pro-oxidants. Moreover, apigenin decreased the elevated pro-inflammatory cytokines and inhibited cell loss in liver and kidney tissues in response to PbAc intoxication in both tissues. The obtained results demonstrated that apigenin could be used to attenuate the molecular, biochemical, and histological alterations associated with Pb exposure due to its potent antioxidant, anti-inflammatory, and antiapoptotic effects.

Dennettia tripetala Combats Oxidative Stress, Protein and Lipid Dyshomeostasis, Inflammation, Hepatic Injury, and Glomerular Blockage in Rats

Dennettia tripetala, better known as 'pepperfruit', is a medicinal plant consumed in West Africa. D. tripetala possesses strong antioxidant properties and contains uvariopsine, an alkaloid which improves bile secretion and liver function. In the present study, the ethanolic extract of D. tripetala fruits was tested for its ability to alleviate pathophysiological conditions bordering on oxidative stress, including protein and lipid dyshomeostasis, inflammation, and hepatic and glomerular injury. Male albino Wistar rats were administered carbon tetrachloride twice a week for two weeks, and the ethanolic extract of D. tripetala fruits was administered from days 8∼14. The serum, liver, and kidneys of the rats were then subjected to biochemical assays and imaging. The extract restored the activities of liver marker enzymes in serum and the concentrations of lipids and proteins in both circulation and the liver to normal. The extract also restored the activities of antioxidant enzymes in liver and kidneys, and the concentrations of urea and creatinine in the blood. The extract also repaired the altered structures of the liver and kidney. Overall, D. tripetala elicited strong medicinal effects in rats. This study showed that the fruits of D. tripetala contain substances that could be extracted or synthesized for use in drugs for the treatment of liver and kidney disease.

Boldenone Undecylenate-Mediated Hepatorenal Impairment by Oxidative Damage and Dysregulation of Heat Shock Protein 90 and Androgen Receptors Expressions: Vitamin C Preventive Role

Boldenone Undecylenate (BLD) is a synthetic derivative of testosterone and a widely used anabolic androgenic steroid. The health risk of BLD use as a pharmaceutical or dietary supplement is still underestimated and under-reported. Vitamin C (VC) has been recognized as an antioxidant with prominent hepatorenal protective effects. This study investigated the possible preventive activity of VC against BLD-induced hepatorenal damage. Forty adult male Wistar rats were classified into five groups: control, vehicle control, VC (orally given 120 mg/kg b. wt./day), BLD (intramuscularly injected 5 mg/kg b. wt./week), and BLD + VC-treated groups. The experiment continued for eight weeks. Serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured. Serum contents of total protein (TP), albumin (ALB), globulin, total cholesterol (TC), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), and very-low-density lipoprotein-cholesterol (VLDL-C) were also assayed. Urea, creatinine, and uric acid levels were determined together with sodium and potassium electrolytes measuring. Moreover, oxidative stress indicators including reduced glutathione (GSH), glutathione peroxidase (GPx), glutathione-S-transferase (GST), and glutathione reductase (GSR) as well as malondialdehyde (MDA) levels were measured in both hepatic and renal tissues. Corresponding histological examination of renal and hepatic tissues was conducted. Besides, immunohistochemical evaluations for androgen receptors protein (AR) and heat shock protein 90 (Hsp 90) expressions were performed. BLD caused significant rises in serum ALT, AST, TP, ALB, TC, TG, LDL-C, VLDL-C, urea, creatinine, uric acid, potassium, and MDA levels. Further, BLD-injected rats showed significant declines in the serum levels of HDL-C, sodium, GSH, GPx, GST, and GSR. Besides, distinct histopathological perturbations were detected in renal and hepatic tissues of BLD-injected rats. AR and Hsp 90 immunoexpression were increased in hepatic and renal tissues. In contrast, VC significantly reversed the BLD-induced hepatorenal damage in co-treated rats but not ameliorated AR protein overexpression. VC could be an efficient preventive supplement for mitigating BLD-induced hepatorenal damage, possibly via controlling oxidative stress events.

Synergistic effect of cranberry extract and losartan against aluminium chloride-induced hepatorenal damage associated cardiomyopathy in rats

The present study was designed to evaluate the effect of cranberry extract (CRAN) and/or losartan (LOS) against aluminium chloride (AlCl₃) induced hepatorenal damage associated cardiomyopathy in rats. To induce hepatorenal and cardiotoxicity, animals were received (AlCl₃; 70 mg/kg i.p.) for 8 weeks day after day and treated with CRAN (100 mg/kg b.wt.) orally daily for 4 weeks started after 4 weeks from AlCl₃ injection accompanied with an administration of LOS (5 mg/kg i.p.) three times weekly for 4 weeks. Our data revealed that, compared to AlCl₃, administration of CRAN extract and LOS produced a significant improvement which was evidenced by a significant amelioration in myocardial and vascular indices, kidney and liver markers, lipid profile and oxidative stress indices. Furthermore, histopathological and immunohistochemical examination reinforced the previous results. It could be concluded that combination of CRAN extract and LOS hindered AlCl₃ induced hepatorenal damage complicated cardiomyopathy in rats.

Alterations in morphology and hepatorenal indices in rats subacutely exposed to bitumen extract

Bitumen is a complex mixture of dense and extremely viscous organic liquids produced by distillation of crude oil during petroleum refining. Nigeria has a large deposit of natural bitumen, yet to be fully exploited. Discharges of petroleum hydrocarbons and other petroleum-derived products have caused environmental pollution and adverse human health effects in several oil-rich communities. In this study, bitumen obtained from a seepage source in Agbabu, the town of first discovery, was used in sub-acute toxicity studies in a rat experimental model, in order to assess potential health risks posed to local populace sequel to full exploitation of bitumen. Dosages were chosen to accommodate low to high cases of environmental exposures. Male Wistar rats were administered, per os, dosages of bitumen extract at 5, 3, 2, and 1 mg/kg body weight. Following euthanasia 28 days later, histological findings revealed severe portal congestion and cellular infiltration in the liver, while in the kidney there were protein casts in the tubular lumen. The relative liver and kidney weights in the 5 mg/kg groups were 34% and 40% higher than in the controls, with a concomitant decrease in food and water consumption. Furthermore, plasma clinical analyses revealed marked elevation in aspartate aminotransferase and triglycerides levels in bitumen extract-intoxicated rats. The results indicate the potential hepatorenal toxicity in adult rats following repeated exposure to bitumen extract.