Evaluation Of GALECTIN-3 As An Inflammatory Marker In HCV Positive Patients With And Without Chronic Kidney Disease

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 . Summary 135 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 Summary 136 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.