Nodular regenerative hyperplasia of the liver: survival and associated features in a UK case series

Morris, Jude; Oien, Karin A.; McMahon, Marie; Forrest, Ewan; Morris, John E.; Stanley, Adrian J.; Campbell, Stewart

doi:10.1097/meg.0b013e3283360021

Cited by 56 publications

(44 citation statements)

References 19 publications

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“…These include NRH, peliosis hepatis, and veno-occlusive disease. NRH has been seen in a variety of hematologic, rheumatologic and lymphoproliferative disorders, and more recently as a result of certain drugs and chemotherapeutic agents, including 6-TG and AZA [42] . The incidence of 6-TG-related NRH ranges from 27-61.5% [28] , and may occur as soon as three months after starting therapy or even after more than four years on therapy [28,[43][44][45][46] .…”

Section: Drug-induced Liver Injury Due To Agents Used Tomentioning

confidence: 99%

Hepatotoxicity of Agents Used in the Management of Inflammatory Bowel Disease

Khokhar

Lewis²

2010

Dig Dis

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Patients with inflammatory bowel disease (IBD) are at risk for hepatobiliary disease and toxicity, and the diagnosis of drug-induced liver disease in patients being treated for IBD can represent a clinical challenge. There are a number of disease states associated with IBD, which are primary sclerosing cholangitis, cholangiocarcinoma and autoimmune hepatitis. There is a wide spectrum of hepatic injury that can occur from the agents used to treat IBD, such as acute or chronic hepatic injury directly attributable to the drugs used to treat IBD (e.g. sulfasalazine, mesalamine, thiopurines, methotrexate, TNF antagonists, quinolone antibiotics); liver toxicity from drugs used to treat complications of immunomodulators and TNF antagonists (e.g. isoniazid for treatment of reactivation tuberculosis), and exacerbation of underlying chronic viral hepatitis with infliximab and other TNF antagonists. Thiopurines are also associated with the development of hepatic vascular lesions, such as nodular regenerative hyperplasia and peliosis hepatic. In addition, biologics can be associated with the reactivation of underlying chronic viral hepatitis, mandating universal screening prior to initiation of TNF-alpha antagonist therapy.

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Section: Drug-induced Liver Injury Due To Agents Used Tomentioning

confidence: 99%

Hepatotoxicity of Agents Used in the Management of Inflammatory Bowel Disease

Khokhar

Lewis²

2010

Dig Dis

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“…At least 12 cases of ascites were reported, however the need for paracentesis was not reported. Ascites is infrequently reported in NRH with patients without HIV [10] . The utility of anticoagulation in patients with NRH is a burgeoning concept.…”

Section: Treatmentmentioning

confidence: 99%

“…Varices were detected in 26% of patients. None of these patients had synthetic liver dysfunction as implicated by normal INR [10] . In another series of 24 patients, similar rates of various clinical features of NRH were reported [11] .…”

Section: Study Type Number Of Patients Clinical Presentationmentioning

confidence: 99%

“…However drug-induced hepatotoxicity has become the prevailing theory. The prolonged exposure to highly active antiretroviral therapy (HAART), namely didanosine (DDI) has been strongly correlated, and in all cases of proposed HAART-associated NRH, DDI has been present in each [5][6][7][8][9][10][11][12][13][14][15] . The significance of the association between NRH and HIV is underscored by the evolving patterns of disease in HIV-infected persons.…”

Section: Introductionmentioning

confidence: 99%

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Human immunodeficiency virus and nodular regenerative hyperplasia of liver: A systematic review

Sood¹,

Castrejon²,

Saab³

2014

WJH

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AIM:To investigate the diagnosis, pathogenesis, natural history, and management of nodular regenerative hyperplasia (NRH) in patients with human immunodeficiency virus (�IV). METHODS:We performed a systematic review of the medical literature regarding NR� in patients with �IV. Inclusion criteria include reports with biopsy proven NR�. We studied the clinical features of NR�, in particular, related to its presenting manifestation and laboratory values. Combinations of the following keywords were implemented: "nodular regenerative hyperplasia", "human immunodeficiency virus", "noncirrhotic portal hypertension", "idiopathic portal hypertension", "cryptogenic liver disease", "highly active antiretroviral therapy" and "didanosine". The bibliographies of these studies were subsequently searched for any additional relevant publications. RESULTS:The clinical presentation of patients with NR� varies from patients being completely asymptomatic to the development of portal hypertensionnamely esophageal variceal bleeding and ascites. Liver associated enzymes are generally normal and synthetic function well preserved. There is a strong association between the occurrence of NR� and the use of antiviral therapies such as didanosine. The management of NR� revolves around treating the manifestations of portal hypertension. The prognosis of NR� is generally good since liver function is preserved. A high index of suspicion is required to make a identify NR�. CONCLUSION:The appropriate management of �IV-infected persons with suspected NR� is yet to be outlined. �owever, NR� is a clinically subtle condition that is difficult to diagnose, and it is important to be able to manage it according to the best available evidence.

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“…In the Western world, it accounts for 14-27% of noncirrhotic portal hypertension (PH) cases [3]. NRH is most commonly seen in association with rheumatologic diseases, exposure to chemotherapy, radiation and immunosuppressive therapy, and prothrombotic conditions including myeloproliferative and lymphoproliferative disorders [4,5]. In the organ transplantation setting, NRH is mostly associated with solid organ transplantation and has rarely been reported as a complication of allogeneic hematopoietic stem cell transplant (HSCT).…”

Section: Tablementioning

confidence: 99%

Nodular Regenerative Hyperplasia Causing Portal Hypertension in a Patient with Chronic Graft versus Host Disease: Response to Sirolimus

et al. 2014

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Nodular regenerative hyperplasia of the liver: survival and associated features in a UK case series

Abstract: NRH is usually associated with malignant, prothrombotic or rheumatological conditions. Survival is highly variable and related to age and the underlying disease process, but not to portal hypertension overall. Liver function remains well preserved.

Cited by 56 publications

References 19 publications

Hepatotoxicity of Agents Used in the Management of Inflammatory Bowel Disease

Hepatotoxicity of Agents Used in the Management of Inflammatory Bowel Disease

Human immunodeficiency virus and nodular regenerative hyperplasia of liver: A systematic review

Nodular Regenerative Hyperplasia Causing Portal Hypertension in a Patient with Chronic Graft versus Host Disease: Response to Sirolimus

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