الفهرس 
Inflammation in hepatitis COnly 14 pages are availabe for public view
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Abstract
Egypt has a very high prevalence of HCV and a high morbidity and mortality from chronic liver disease, cirrhosis, and hepatocellular carcinoma.
Liver fibrosis is defined as an abnormal accumulation of extracellular matrix in the liver. Its endpoint is liver cirrhosis which is responsible for a significant morbidity and mortality.
Cirrhosis is an advanced stage of fibrosis, characterised by formation of regenerative nodules of liver parenchyma separated by fibrotic septa, which result from cell death, aberrant extracellular matrix deposition and vascular reorganisation. Advanced liver fibrosis results in cirrhosis, liver failure, and portal hypertension and often requires liver transplantation .
Removing the insult and stopping the persistent inflammatory stimuli is probably the best way to prevent progression of fibrosis; this has been shown in many patients with chronic hepatitis C and in smaller numbers of patients with autoimmune hepatitis.
Clinical data confirmed that, providing appropriate, targeted treatment to patients with histologically advanced liver disease, especially those with autoimmune hepatitis, may improve their long-term outcome.
Nevertheless, prevention of the progression of fibrosis to cirrhosis remains the major clinical goal. The poor prognosis of cirrhosis is aggravated by the frequent occurrence of hepatocellular carcinoma .
Inflammation is a key factor in the initiation and maintenance of fibrotic processes within the liver
Hepatitis C virus (HCV) is also associated with a wide spectrum of clinical and biological extrahepatic manifestations.
In chronically infected patients, the virus can trigger an impairment in lymphoproliferation with cryoglobulin production
Mixed cryoglobulinemia with its complications (skin, neurological, renal, and rheumatologic) is the most significant extrahepatic manifestation of HCV infection .
CKD is a major global health issue. It is estimated that up to 19 million Americans have CKD and 350,000 are currently on dialysis .
CKD stage 5, known as End-Stage Renal Disease (ESRD), is defined by GFR <15 mllminll .73m2 and characterized by bilateral, progressive,chronic deterioration of nephrons, which are the kidney functional units. The kidneys are no longer able to maintain normal homeostasis resulting in uremia caused by renal failure, retention of excretory products, and interference with endocrine and metabolic functions .
When conservative treatment fails and the number of functional nephrons is reduced to the point that the kidneys can no longer filter the blood and adequately remove nitrogen-containing compounds, either renal replacement therapy or renal transplantation is necessary .
Even though the high prevalence of chronic inflammation and its link to poor outcome in (CKD) are not news any more, many clinicians and investigators remain interested in research about inflammatory markers in kidney disease :
a) Recent studies, both epidemiologic and basic science, have suggested that in the general population, chronic inflammation may have a stronger causal role in engendering atherosclerotic cardiovascular disease than LDL hypercholesterolemia.
b) Inflammation seems to be at least one of the reasons for the high burden of atherosclerotic cardiovascular disease and death in individuals with CKD.
c) Patients with CKD and higher serum levels of inflammatory markers such as C-reactive protein (CRP) and IL-6 have a higher rate of CKD progression and poor clinical outcomes, including higher death rates.
d) Inflammation may be the missing link between the surrogates of malnutrition-wasting syndrome such as hypoalbuminemia and poor survival in patients with CKD, especially. Those who undergo maintenance dialysis treatment .
Anti-inflammatory treatments may be our last best hope, because decades of treating such conventional risk factors as hypercholesterolemia and hypertension have not improved survival in dialysis patients.
On the basis of these premises, many nephrologists are interested in relevant information about the inflammatory markers and their associations with both CKD progression and cardiovascular disease and death in this population
Normally, galectin-3 is found in small amounts within our bodies. But, higher than average levels of this molecule indicate the presence of a wide array of degenerative processes in the body, most notably cancer proliferation/ metastases, heart failure, chronic inflammation, fibrosis and related organ failure
Over-expression of galectin-3 is also directly involved in a variety of processes associated with heart failure, including myofibroblast proliferation, inflammation and fibrogenesistissue repair, and ventricular and tissue remodeling. Elevated levels of galectin-3 in the blood have been found to be significantly associated with higher risk of death in acute decompensated heart failure as well as chronic heart failure populations.
Findings illustrate the potential importance of measuring galectin-3 in HCV positive patients .the hope is that early detection of increasing level of galectin-3 will help in predicting renal impairment in early stage
There have been anumber of papers published on elevated galectin-3 level preceed CKD also in case of fibrosis
Therefore , a study like this type could provide information about galectin-3 level difference in patients with HCV positive patients with normal kidney functions and with CKD.
Patients will be characterized according to:
Age, sex, HCV positive, Renal involvement .
Patient will be divided into 3 groups
1-healthy group (group 1).
2-HCV positive patients with normal kidney functions (group 2).
3-HCV positive patients with CKD (group 3).
Blood samples for assessment of
• Complete blood picture (CBC).
• CRP titre.
• Serum creatinine, blood urea nitrogen.
• Serum uric acid,Na, K.
• Liver function tests
(AST, ALT, Bilirubin, Serum Albumin).
• PT,INR
• Assessment of Galectin-3 level in serum:
Serum Gal-3 levels will be measured in the sera of these patients and healthy controls, using an enzyme-linked immunosorbent assay (ELISA) kit (Bender MedSystems GmbH, Austria).