Effects of urodilatin on natriuresis in cirrhosis patients with sodium retention

BACKGROUND: Sodium retention and ascites are serious clinical problems in cirrhosis. Urodilatin (URO) is a peptide with paracrine effects in decreasing sodium reabsorption in the distal nephron. Our aim was to investigate the renal potency of synthetic URO on urine sodium excretion in cirrhosis patients with sodium retention and ascites. METHODS: Seven cirrhosis patients with diuretics-resistant sodium retention received a short-term (90 min) infusion of URO in a single-blind, placebo-controlled cross-over study. In the basal state after rehydration the patients had urine sodium excretion < 50 mmol/24 h. RESULTS: URO transiently increased urine sodium excretion from 22 ± 16 μmol/min (mean ± SD) to 78 ± 41 μmol/min (P < 0.05) and there was no effect of placebo (29 ± 14 to 44 ± 32). The increase of URO's second messenger after the receptor, cGMP, was normal. URO had no effect on urine flow or on blood pressure. Most of the patients had highly elevated plasma levels of renin, angiotensin II and aldosterone and URO did not change these. CONCLUSION: The short-term low-dose URO infusion increased the sodium excretion of the patients. The increase was small but systematic and potentially clinically important for such patients. The small response contrasts the preserved responsiveness of the URO receptors. The markedly activated systemic pressor hormones in cirrhosis evidently antagonized the local tubular effects of URO

Antimitochondrial and antinuclear antibodies in primary biliary cirrhosis: an update in relation to their biochemical characterization and clinical significance.

Antimitochondrial antibodies are found in 85 to 95% of patients with primary biliary cirrhosis. Nine different patterns have been identified but only four are associated with primary biliary cirrhosis. Anti-M2 antibodies are specific for the disease. The M2 antigen was found to be composed of five antigen determinants and related to the E2 component of three multienzyme complexes located within mitochondria. Anti-M4 and M8 antibodies appear invariably associated with anti-M2 and are markers for the "overlap syndrome" between primary biliary cirrhosis and chronic active hepatitis as well as for poor prognosis. Anti-M9 antibodies are preferentially associated with early and/or asymptomatic disease. Antinuclear antibodies are found in 24 to 58% of patients with primary biliary cirrhosis. Six various patterns have been reported. Antibodies directed to the 200 kD polypeptide of the nuclear pore and giving a perinuclear fluorescence are specific for primary biliary cirrhosis. Patients with such antibodies exhibit a less symptomatic disease and lower titers of anti-M2 than those without

Benign recurrent intrahepatic cholestasis. A report of 26 cases.

Benign recurrent intrahepatic cholestasis is characterized by attacks of cholestasis. The purpose of our study of 26 patients was to emphasize some features uncommonly or never reported in this disease: (a) in each patient, the attacks of cholestasis were stereotypic; (b) attacks of cholestasis were not associated with pruritus in 15% of our patients; (c) the occurrence of attacks of cholestasis during pregnancy or oral contraceptive use might be a fortuitous coincidence; (d) gallstones were found in several patients with benign recurrent intrahepatic cholestasis and might be present earlier than in the general population; (e) in some of our patients, during attacks of cholestasis, serum transaminases were very high, exceeding 15 times the upper limit of normal; (f) mild portal inflammatory infiltration was found in one third of our patients; (g) no treatment shortened the duration of cholestasis, and in a few patients, plasmapheresis seemed to diminish jaundice and improve biochemical disorders

Hépatites chroniques virales et interférons: résultats préliminaires chez 60 patients porteurs d'une hépatite chronique C et mécanismes d'action cellulaire

Interferons exhibit antiviral and immunomodulatory properties. Antiviral effects appear mainly mediated via 2'5' oligoadenylate synthetase and protein kinase proteins which inhibit viral components synthesis. Interferons also influence the immune system through various mechanism among whom an increased expression of HLA class I antigens on hepatocyte plasma membrane and the promotion of natural killer cell activity leading to the clearance of infected hepatocytes. We report the results of various alpha interferon therapeutic regimens in 60 patients with chronic hepatitis C. In our series, 20 patients (33%) achieved a complete response but 78% of them relapsed after therapy withdrawal. Predictors of good response include young age, low serum ALT levels and mild liver injury. On the contrary, cirrhosis is associated with a poorer response