Improvement in liver histology due to lifestyle modification is independently associated with improved kidney function in patients with non-alcoholic steatohepatitis.

BACKGROUND: Several recent studies have shown a strong association between non-alcoholic steatohepatitis (NASH) and chronic kidney disease. AIM: To examine the relationship between changes in liver histology and renal function in patients with NASH. METHODS: The present analysis represents a post hoc analysis of a recently published trial that included 261 patients with NASH who were treated with lifestyle modifications during 52 weeks. Kidney function was evaluated through Chronic Kidney Disease Epidemiology Collaboration estimated glomerular filtration rates (eGFR, mL/min/1.73 m2 ) overtime. We explored correlations between the kidney function and improvement in histological outcomes at 52 weeks. RESULTS: Interestingly, a one-stage reduction in fibrosis (r = 0.20, P < 0.01) and resolution of NASH (r = 0.17, P < 0.01) were significantly correlated with an improvement in the kidney function. The eGFR values significantly increased in patients with fibrosis improvement (+7.6 ± 6.5 mL/min/1.73 m2 ), compared to those without fibrosis improvement (-1.98 ± 6.4 mL/min/1.73 m2 ) (P < 0.01) at end of treatment (EOT). Likewise, NASH resolution was associated with an increase in eGFR compared with patients without NASH resolution (2.32 ± 7.8 mL/min/1.73 m2 vs. -1.04 ± 5.9 mL/min/1.73 m2 , P = 0.04) at EOT. After controlling for the confounders, the association between fibrosis improvement, NASH resolution and eGFR change remained significant (P < 0.05 for both). CONCLUSIONS: Improvement in liver histology due to lifestyle modification is independently associated with improved kidney function in NASH. As new drugs for NASH emerge, studies should address whether improvement in histology in response to pharmacotherapies yield the same improvement in kidney function as weight loss.

[Minimal hepatic encephalopathy]. / Encefalopatía hepática mínima.

Minimal hepatic encephalopathy (MHE) is defined by the presence of neurophysiological alterations,with an important impact in the quality of life, in the risk of performing dangerous tasks as leading cars and heavy machinery and increases risk of overt hepatic encephalopathy. MHE is present in a third of cirrhotic depending on liver function. Psychometric and neurophysiologic test are used in the diagnosis of MHE, mainly PHES (Psychometric Hepatic Encephalopathy Score) battery, electroencephalogram, evoked potentials and measurement of the critical flicker frequency. Oral glutamine challenge (OGC) measures intestinal ammonia production after glutamine intake and indirectly intestinal glutaminase activity. Altered OGC in patients with MHE predicts short-time survival. In conclusion,MHE is the first stage in HE syndrome, affect to a third of cirrhotic and worsen quality of life. There are useful and easy-to-use diagnostic tests and new therapeutic options are warranted.