Hépatologie et science pancréatique

Steatotic liver disease, commonly known as fatty liver disease, is a condition characterized by excess fat accumulation in the liver. It is often associated with metabolic syndrome, obesity, and type 2 diabetes. There are two primary forms: alcoholic fatty liver disease and non-alcoholic fatty liver disease. Recently, the potential of testosterone replacement therapy to improve steatotic liver disease has garnered significant attention. The primary risk factors for NAFLD include obesity, insulin resistance, hypertension, and dyslipidemia. The pathogenesis of steatotic liver disease involves complex interactions between metabolic, genetic, and environmental factors. Testosterone, a key male sex hormone, plays a vital role in various bodily functions, including muscle mass maintenance, fat distribution, and metabolism. Low testosterone levels, or hypogonadism, have been linked to an increased risk of metabolic syndrome and type 2 diabetes, conditions closely associated with NAFLD.

Methotrexate is a cornerstone medication in the management of various autoimmune diseases, including rheumatoid arthritis, psoriasis, and inflammatory bowel disease. However, its use is associated with the risk of liver toxicity, including fibrosis, which can progress to cirrhosis in severe cases. Liver elastography has emerged as a valuable tool for non-invasive assessment of liver fibrosis, offering significant advantages over traditional biopsy. This article explores the application of liver elastography in detecting and monitoring MTX-induced liver fibrosis. MTX is an antimetabolite and antifolate drug that exerts its therapeutic effects by inhibiting dihydrofolate reductase, thus interfering with folate metabolism. While highly effective in managing autoimmune conditions, MTX can lead to hepatotoxicity, with liver fibrosis being a common manifestation. The exact pathogenesis of MTX-induced liver fibrosis is multifactorial and not fully elucidated but likely involves oxidative stress, inflammatory cytokines, and genetic predisposition.

Acute liver injury and acute kidney injury are critical conditions often seen in hospitalized patients, each associated with significant morbidity and mortality. The intersection of these two conditions can compound patient outcomes, presenting a complex clinical challenge. This article explores the incidence, risk factors, and outcomes of ALI in patients with AKI, based on data from a large multicenter study. ALI is characterized by a sudden increase in liver enzymes, indicating liver cell damage. AKI involves a rapid decline in kidney function, leading to the accumulation of waste products in the body. Both conditions can arise from various etiologies, including drug toxicity, infections, ischemia, and underlying chronic diseases. The interplay between liver and kidney functions, often referred to as the hepatorenal axis, suggests that dysfunction in one organ can significantly impact the other.

Cirrhosis, a late stage of scarring of the liver, is a condition often resulting from various liver diseases and conditions, such as hepatitis and chronic alcoholism. Recent research has highlighted the impact of dietary factors on the progression and outcomes of cirrhosis. A study examining the association between dietary acid load and cirrhosis-related mortality has brought to light the significant influence of diet on liver health and patient outcomes. Dietary acid load refers to the balance of acid-producing and alkaline-producing foods in one's diet. Foods high in protein and grain products generally produce acid, while fruits and vegetables tend to produce alkaline. The body maintains a stable pH balance, but a diet high in acid-producing foods can lead to metabolic acidosis, which has been implicated in various health issues, including kidney disease and osteoporosis.