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Clinical and pathophysiological understanding of the hepatorenal syndrome:Still wrong or still not exactly right?

World Journal of Clinical Cases 2023年第6期11卷 1261-1266页

作者： Benjamin Wilde Ali Canbay antonios katsounas Department of Nephrology University of Duisburg-EssenUniversity Hospital EssenEssen 45147Germany Department of Medicine Ruhr University BochumBochum 44892Germany

The hepatorenal syndrome(HRS)is one major extrahepatic complication of endstage liver *** circulatory dysregulation is considered as primary etiology for HRS,cirrhosis-related(systemic)inflammation and/or cardial dysfunction may also play a key pathogenic role in HRS *** of other causes of acute kidney injury(AKI)is required for diagnosis of HRS-AKI by the definition of the International Club of ***,the pathophysiology of HRS is not understood completely and there are still limited therapeutic *** of renal dysfunction after liver transplantation indicates that HRS-AKI is a functional disorder caused by altered cellular *** interplay between systemic inflammation and the onset of kidneyrelated hypometabolism may have a key role and needs to be studied in *** minireview challenges simplified views of the HRS in the context of diagnostics and therapy stressing the need for further evidence to advance the knowledge on this syndrome.

关键词： Hepatorenal syndrome Liver disease Cirrhosis Inflammation Chronic kidney disease Acute kidney injury

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A Multipathogen Bile Sample-based PCR Assay Can Guide Empirical Antimicrobial Strategies in Cholestatic Liver Diseases

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Journal of Clinical and Translational Hepatology 2022年第5期10卷 788-795页

作者： Michael Jahn Mustafa KÖzçürümez Sebastian Dolff Hana Rohn Dominik Heider Alexander Dechêne Ali Canbay Peter M.Rath antonios katsounas Department of Nephrology University Hospital EssenUniversity of Duisburg-EssenEssenGermany Department of Medicine Universitätsklinikum Knappschaftskrankenhaus BochumRuhr-University BochumBochumGermany Department of Infectious Diseases University Hospital EssenUniversity of Duisburg-EssenEssenGermany Department of Mathematics and Computer Science University of MarburgMarburgGermany Department for Internal Medicine Nuremberg Hospital NorthParacelsus Private Medical University NurembergNurembergGermany Institute of Medical Microbiology University Hospital EssenUniversity of Duisburg-EssenEssenGermany

Background and objectives:Polymerase chain reaction(PCR)techniques provide rapid detection of *** pilot study evaluated the diagnostic utility and clinical impact of multiplex real-time PCR(mRT-PCR,SeptiFast)*** microbial culture(CMC)in bile samples of patients with chronic cholestatic liver diseases(cCLDs),endoscopic retrograde cholangio-pancreatography(ERCP),and peri-interventional-antimicrobial-prophylaxis(pAP).Methods:We prospectively collected bile samples from 26 patients for microbiological analysis by CMC and *** of the results of both methods was determined by Krippendorff's alpha(α)for inter-rater reliability and the Jaccard index of ***:mRT-PCR_(bile)and CMC_(bile)results were concordant for only Candida albicans(α=0.8406;Jaccard index=0.8181).mRT-PCR_(bile)detected pathogens in 8/8 cases(100%),CMC_(bile)in 7/8(87.5%),and CMCblood in 5/8(62.5%)with clinical signs of ***_(bile),CMC_(bile),and CMCblood had identical detection results in 3/8(37.5%)with clinical signs of infection(two Klebsiella *** one Enterococcus faecium).The total pathogen count was significantly higher with mRT-PCR_(bile)than with CMC_(bile)(62 vs.31;χ^(2)=30.031,p<0.001).However,pathogens detected by mRT-PCR_(bile)were more often susceptible to pAP according to the patient infection/colonization history(PI/CH)and surveillance data for antibiotic resistance in our clinic(DARC).Pathogens identified by mRT-PC_(Rbile)and resistant to pAP by PI/CH and DARC were likely to be clinically ***:mRT-PCR in conjunction with CMCs for bile analysis increased diagnostic sensitivity and may benefit infection management in patients with cholestatic *** of mRT-PCR in a bile sample-based diagnostic routine can support more rapid and targeted use of antimicrobial agents in cCLD-patients undergoing ERCP and reduce the rate/length of unnecessary administration of broad-spectrum antibiotics.

关键词： ERCP PCR Antibiotic prophylaxis Cholestasis Cholangitis

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