Drug-Induced Nodular Regenerative Hyperplasia

Ghabril, Marwan; Vuppalanchi, Raj

doi:10.1055/s-0034-1375963

Cited by 53 publications

(39 citation statements)

References 26 publications

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“…In the current study, we found a good correlation between LSM and HVPG that is likely indicative of the severity of NRH and underlying portal hypertension. It is therefore conceivable that early in the course of NRH, the HVPG may be low primarily due to presinusoidal portal hypertension . It is also possible that the variation in LSM in NRH is reflective of the predominant mechanism of injury (i.e., low LSM in presinusoidal versus high LSM in sinusoidal portal hypertension) .…”

Section: Discussionmentioning

confidence: 99%

Liver Stiffness Measurements in Patients with Noncirrhotic Portal Hypertension—The Devil Is in the Details

et al. 2018

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Noncirrhotic portal hypertension (NCPH) is often a diagnostic challenge due to signs and symptoms of portal hypertension that overlap with cirrhosis. The etiology of NCPH is broadly classified as prehepatic, hepatic (presinusoidal and sinusoidal) and posthepatic. Some common etiologies of NCPH encountered in clinical practice include portal vein thrombosis (prehepatic) and nodular regenerative hyperplasia (hepatic). Liver histology, although considered gold standard to exclude cirrhosis in individuals with suspected NCPH, is often limited by subtle histologic features or inadequate sampling. Liver stiffness measurements (LSMs) by vibration-controlled transient elastography may provide clinically important information to distinguish NCPH from cirrhosis by revealing normal LSM in prehepatic and presinusoidal NCPH.

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Section: Discussionmentioning

confidence: 99%

Liver Stiffness Measurements in Patients with Noncirrhotic Portal Hypertension—The Devil Is in the Details

et al. 2018

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“…NRH is characterized by widespread transformation of nor mal liver parenchyma into hyperplastic regenerative nodules without bridging fibrosis, a characteristic that distinguishes this entity from liver cirrhosis (15). This injury is characteristically asymptomatic in its early phases, with only mild elevations in transaminase levels (16). Ox aliplatin is a well-known causative drug for the development of NRH (17).…”

Section: Discussionmentioning

confidence: 99%

Pseudocirrhosis caused by regorafenib in an advanced rectal cancer patient with multiple liver metastases

Kumamoto

Endo

Isohata

et al. 2016

Molecular and Clinical Oncology

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Abstract.A 70-year-old man who was diagnosed with unresectable advanced rectal cancer with multiple liver metastases, received oxaliplatin-based treatment with bevacizumab as first-line chemotherapy and irinotecan-based treatment with bevacizumab as second-line chemotherapy for a total of 17 months. The patient was treated with regorafenib (160 mg/day for 3 weeks) as third-line chemotherapy. Following completion of one course of regorafenib treatment, the patient complained of abdominal distension. Computed tomography (CT) examination identified liver atrophy and massive ascites, while no such symptoms were observed prior to the regorafenib treatment. Blood testing revealed increases in the aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) levels. The patient was admitted to the Aizu Medical Center (Aizuwakamatsu, Japan). Approximately 2,000 ml of ascitic fluid were aspirated daily for 1 week by abdominal puncture. The patient was administered oral diuretics, including 20 mg/day of furosemide and 25 mg/day of spironolactone. Albumin was administered to correct the albumin deficit. The levels of AST, ALT and ALP were decreased from the peak value reported on admission and the patient was discharged from our hospital 16 days following treatment initiation. The CT examination after 1 month revealed that the volume of the liver had been restored and the ascites had disappeared. Furthermore, almost all the liver metastases were reduced in size. The carcinoembryonic antigen level, which was elevated prior to regorafenib treatment, also decreased to normal.

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“…Nodular regenerative hyperplasia (NRH) may be present on a liver biopsy (Figure 1), but other times histology is unrevealing. Several medications including oral contraceptives, anti-neoplastic drugs and immunosuppressive agents have been implicated (27, 28). Due to the indolent development of portal hypertension from stellate cell stimulation and liver regeneration, latency periods can be long and well after drug discontinuance.…”

Section: Specific Chronic Injuriesmentioning

confidence: 99%

Long-Term Outcomes After Drug-Induced Liver Injury

Hayashi

Bjõrnsson

2018

Curr Hepatology Rep

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Purpose of the review: This review serves to update the reader on emerging data regarding a spectrum of drug-induced liver injury (DILI) outcomes that lie between complete resolution and acute liver failure. Such outcomes can range from mild chronic injury to late liver failure and mortality. Recent findings: Several large registries are maturing with large numbers of DILI cases thus shedding light on outcomes including chronic injury and late fatality. We cover definitions commonly used to describe resolution versus chronic injury and mortality due to DILI. We look at rates of occurrence for these different outcomes in major registries. Three specific types of chronic DILI that are illustrative but also easily missed by clinicians are also described. Summary: A small but important proportion of DILI cases do not resolve, going on to develop chronic injury and even liver failure. Defining and recognizing these cases is a challenge because DILI is rare, and chronic injury rarer still. Large registries are beginning to define these previously overlooked long term outcomes.

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Drug-Induced Nodular Regenerative Hyperplasia

Cited by 53 publications

References 26 publications

Liver Stiffness Measurements in Patients with Noncirrhotic Portal Hypertension—The Devil Is in the Details

Liver Stiffness Measurements in Patients with Noncirrhotic Portal Hypertension—The Devil Is in the Details

Pseudocirrhosis caused by regorafenib in an advanced rectal cancer patient with multiple liver metastases

Long-Term Outcomes After Drug-Induced Liver Injury

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