nach oben

Current Hepatology Reports

Erschienen in:

13.06.2018 | Hepatitis B (JK Lim, Section Editor)

Extrahepatic Manifestations of Chronic Hepatitis B Infection

verfasst von: Victor Virlogeux, Christian Trépo

Erschienen in: Current Hepatology Reports | Ausgabe 3/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Hepatitis B virus (HBV) is responsible for over 350 million chronic carriers, 50% of whom will die prematurely from cirrhosis and hepatocellular carcinoma associated with T cell-mediated cytopathic immune clearance of the virus occurring over lifetime. Around 20% of acute and chronic HBV carriers are experiencing a great range of extrahepatic manifestations related to complex immunological mechanisms.

Recent Findings

Extrahepatic manifestations are due to circulating immune complexes or possibly local inflammation triggered by viral antigens and activating the complement cascade. Their mechanism and severity are unrelated to progression of liver disease. The exact viral trigger antigens remain elusive and the most likely candidates could be hepatitis B e antigen.

The spectrum of the lesion includes acute infection serum sickness, vasculitis including, polyarteritis nodosa and the most affected organs are skin, large joints, muscles, and kidneys.

Summary

Prompt awareness of these extrahepatic manifestations is now of paramount importance, since well-tolerated nucleoside analogues devoid of resistance are capable of inhibiting HBV replication and have proven not only lifesaving but remarkably also curative, like for PAN, turning as the most prophetic illustration of HBV cure.

Lavanchy D. Worldwide epidemiology of HBV infection, disease burden, and vaccine prevention. J Clin Virol. 2005;34:S1–3.PubMed

•• Trépo C, HLY C, Lok A. Hepatitis B virus infection. Lancet. 2014;384:2053–63. Overall review on Hepatitis B infection. PubMed

Kappus MR, Sterling RK. Extrahepatic manifestations of acute hepatitis B virus infection. Gastroenterol Hepatol (N Y). 2013;9:123–6.

Mazzaro C, Dal Maso L, Urraro T, Mauro E, Castelnovo L, Casarin P, et al. Hepatitis B virus related cryoglobulinemic vasculitis: a multicentre open label study from the Gruppo Italiano di Studio delle Crioglobulinemie - GISC. Dig Liver Dis. 2016;48:780–4.PubMed

Singh H, Tanwar VS, Sukhija G, Kaur P, Govil N. Vasculitis as a presenting manifestation of chronic hepatitis B virus infection: a case report. J Clin Diagn Res. 2016;10:OD25–6.PubMedPubMedCentral

•• Trepo C, Guillevin L. Polyarteritis nodosa and extrahepatic manifestations of HBV infection: the case against autoimmune intervention in pathogenesis. J Autoimmun. 2001;16:269–74. Review on mechanisms and outcome of hepatitis B polyarteritis nodosa. PubMed

Kussmaul A, Maier R. Ueber eine bisher nicht beschriebene eigenthumliche Arterienerkrankung Periarteritis Nodosa die mit Morbus Brightii und rapid fortschreintender allgemeiner Muskellahmung einhergeht. Deutsches Archiv für Klinische Medizin. Dtsch Arch Klin Med. 1866;1:484.

Trepo C, Thivolet J. Hepatitis associated antigen and periarteritis nodosa (PAN). Vox Sang. 1970;19:410–1.PubMed

Trepo C, Thivolet J. Antigene Australia, virus de l’hépatite et périartérite noueuse. Presse Med. 1970;78:1575.PubMed

10.

Gocke DJ, Hsu K, Morgan C, Bombardieri S, Lockshin M, Christian CL. Vasculitis in association with Australia antigen. J Exp Med. 1971;134:330–6.PubMedPubMedCentral

11.

Prince AM, Trepo C. Role of immune complexes involving SH antigen in pathogenesis of chronic active hepatitis and polyarteritis nodosa. Lancet. 1971;1:1309–12.PubMed

12.

McMahon BJ, Bender TR, Templin DW, Maynard JE, Barrett DH, Berquist KR, et al. Vasculitis in Eskimos living in an area hyperendemic for hepatitis B. JAMA. 1980;244:2180–2.PubMed

13.

•• Guillevin L, Mahr A, Callard P, Godmer P, Pagnoux C, Leray E, et al. Hepatitis B virus-associated polyarteritis nodosa: clinical characteristics, outcome, and impact of treatment in 115 patients. Medicine (Baltimore). 2005;84:313–22. Impact of various treatment on polyarteritis nodosa.

14.

De Virgilio A, Greco A, Magliulo G, Gallo A, Ruoppolo G, Conte M, et al. Polyarteritis nodosa: a contemporary overview. Autoimmun Rev. 2016;15:564–70.PubMed

15.

Pagnoux C, Seror R, Henegar C, Mahr A, Cohen P, Le Guern V, et al. Clinical features and outcomes in 348 patients with polyarteritis nodosa: a systematic retrospective study of patients diagnosed between 1963 and 2005 and entered into the French Vasculitis Study Group Database. Arthritis Rheum. 2010;62:616–26.PubMed

16.

Mason A, Theal J, Bain V, Adams E, Perrillo R. Hepatitis B virus replication in damaged endothelial tissues of patients with extrahepatic disease. Am J Gastroenterol. 2005;100:972–6.PubMed

17.

Guillevin L, Jarrousse B, Lok C, Lhote F, Jais JP, Le Thi Huong Du D, et al. Long-term follow-up after treatment of polyarteritis nodosa and Churg-Strauss angiitis with comparison of steroids, plasma exchange and cyclophosphamide to steroids and plasma exchange. A prospective randomized trial of 71 patients. The Cooperative Study Group for Polyarteritis Nodosa. J Rheumatol. 1991;18:567–74.PubMed

18.

• Guillevin L, Lhote F, Leon A, Fauvelle F, Vivitski L, Trepo C. Treatment of polyarteritis nodosa related to hepatitis B virus with short term steroid therapy associated with antiviral agents and plasma exchanges. A prospective trial in 33 patients. J Rheumatol. 1993;20:289–98. HBV PAN curative physiopathological combination therapy. PubMed

19.

Trepo C, Ouzan D, Delmont J, Tremisi P. Superiorite d’un nouveau traitement curateur des periarterites noueuses induites par le virus de l’hepatite B grace a l’association corticotherapie breve, vidarabine et echanges plasmatiques. Presse Med. 1988;17:1527–31.PubMed

20.

Guillevin L, Merrouche Y, Gayraud M, Jarrousse B, Royer I, Leon A. Périartérite noueuse due au virus de l’hépatite B. Détermination d’une nouvelle stratégie thérapeutique chez 13 patients. Presse Med. 1988;17:1522–6.PubMed

21.

Guillevin L, Lhote F, Sauvaget F, Deblois P, Rossi F, Levallois D, et al. Treatment of polyarteritis nodosa related to hepatitis B virus with interferon-alpha and plasma exchanges. Ann Rheum Dis. 1994;53:334–7.PubMedPubMedCentral

22.

Guillevin L, Mahr A, Cohen P, Larroche C, Queyrel V, Loustaud-Ratti V, et al. Short-term corticosteroids then lamivudine and plasma exchanges to treat hepatitis B virus-related polyarteritis nodosa. Arthritis Rheum. 2004;51:482–7.PubMed

23.

Auguet T, Barragan P, Ramírez R, Quer JC, Sirvent JJ, Richart C. Lamivudine in the treatment of hepatitis B virus-related polyarteritis nodosa. J Clin Rheumatol. 2007;13:298–9.PubMed

24.

• Balwani MR, Kute VB, Shah PR, Shah M, Shinde SG, Shah J, et al. Hepatitis B viremia manifesting as polyarteritis nodosa and secondary membranous nephropathy. J Nephropharmacol. 2016;5:119–21. Recent report of successful NUC HBV therapy for HBV extrahepatic manifestations. PubMedPubMedCentral

25.

Alter H, Block T, Brown N, Brownstein A, Brosgart C, Chang K-M, et al. A research agenda for curing chronic hepatitis B virus infection: Alter et al. Hepatology. 2018;67:1127–31.PubMed

26.

Gupta A, Quigg RJ. Glomerular diseases associated with hepatitis B and C. Adv Chronic Kidney Dis. 2015;22:343–51.PubMed

27.

Bhimma R, Coovadia HM. Hepatitis B virus-associated nephropathy. Am J Nephrol. 2004;24:198–211.PubMed

28.

Ren J, Wang L, Chen Z, Ma ZM, Zhu HG, Yang DL, et al. Gene expression profile of transgenic mouse kidney reveals pathogenesis of hepatitis B virus associated nephropathy. J Med Virol. 2006;78:551–60.PubMed

29.

Deng C-L. Chronic hepatitis serum promotes apoptotic damage in human renal tubular cells. World J Gastroenterol. 2006;12:1752–6.PubMedPubMedCentral

30.

•• Brzosko WJ, Krawczyński K, Nazarewicz T, Morzycka M, Nowoslawski A. Glomerulonephritis associated with hepatitis-B surface antigen immune complexes in children. Lancet. 1974;2:477–82. First study to report the involvement of HBV in the pathogenesis of glomerulonephritis. PubMed

31.

Willson RA. Extrahepatic manifestations of chronic viral hepatitis. Am J Gastroenterol. 1997;92:3–17.PubMed

32.

Dienstag JL. Immunopathogenesis of the extrahepatic manifestations of hepatitis B virus infection. Springer Semin Immunopathol. 1981;3:461–72.PubMed

33.

Kupin WL. Viral-Associated GN: Hepatitis B and Other Viral Infections. Clin J Am Soc Nephrol [Internet]. 2016 [cited 2017 Mar 22]; Available from: http://cjasn.asnjournals.org/cgi/doi/10.2215/CJN.09180816.

34.

Nagy J, Bajtai G, Brasch H, Süle T, Ambrus M, Deák G, et al. HBsaG in renal disease. Lancet. 1978;2:315–6.PubMed

35.

Combes B, Shorey J, Barrera A, Stastny P, Eigenbrodt EH, Hull AR, et al. Glomerulonephritis with deposition of Australia antigen-antibody complexes in glomerular basement membrane. Lancet. 1971;2:234–7.PubMed

36.

Chan TM. Hepatitis B and Renal Disease. Curr Hepat Rep. 2010;9:99–105.PubMedPubMedCentral

37.

Chen L, Wu C, Fan X, Gao J, Yin H, Wang T, et al. Replication and infectivity of hepatitis B virus in HBV-related glomerulonephritis. Int J Infect Dis. 2009;13:394–8.PubMed

38.

Kohler PF. Chronic membranous glomerulonephritis caused by hepatitis B antigen-antibody immune complexes. Ann Intern Med. 1974;81:448–51.PubMed

39.

Wada Y, Ogata H, Takeshige Y, Takeshima A, Yoshida N, Yamamoto M, et al. Clinical significance of IgG deposition in the glomerular mesangial area in patients with IgA nephropathy. Clin Exp Nephrol. 2013;17:73–82.PubMed

40.

Wang N-S, Wu Z-L, Zhang Y-E, Liao L-T. Existence and significance of hepatitis B virus DNA in kidneys of IgA nephropathy. World J Gastroenterol. 2005;11:712–6.PubMedPubMedCentral

41.

Liang TJ. Hepatitis B: the virus and disease. Hepatology. 2009;49:S13–21.PubMed

42.

Ozdamar SO, Gucer S, Tinaztepe K. Hepatitis-B virus associated nephropathies: a clinicopathological study in 14 children. Pediatr Nephrol. 2003;18:23–8.PubMed

43.

Gilbert RD, Wiggelinkhuizen J. The clinical course of hepatitis B virus-associated nephropathy. Pediatr Nephrol. 1994;8:11–4.PubMed

44.

Lai KN, Li PK, Lui SF, Au TC, Tam JS, Tong KL, et al. Membranous nephropathy related to hepatitis B virus in adults. N Engl J Med. 1991;324:1457–63.PubMed

45.

Lai KN, Tang SCW, Schena FP, Novak J, Tomino Y, Fogo AB, et al. IgA nephropathy. Nat Rev Dis Primers. 2016;2:16001.PubMed

46.

Khaira A, Upadhyay BK, Sharma A, Das P, Mahajan S, Makhariya G, et al. Hepatitis B virus associated focal and segmental glomerular sclerosis: report of two cases and review of literature. Clin Exp Nephrol. 2009;13:373–7.PubMed

47.

Lai KN, Tam JS, Lin HJ, Lai FM. The therapeutic dilemma of the usage of corticosteroid in patients with membranous nephropathy and persistent hepatitis B virus surface antigenaemia. Nephron. 1990;54:12–7.PubMed

48.

Cadrobbi P, Bortolotti F, Zacchello G, Rinaldi R, Armigliato M, Realdi G. Hepatitis B virus replication in acute glomerulonephritis with chronic active hepatitis. Arch Dis Child. 1985;60:583–5.PubMedPubMedCentral

49.

Lai FM, Tam JS, Li PK, Lai KN. Replication of hepatitis B virus with corticosteroid therapy in hepatitis B virus related membranous nephropathy. Virchows Arch A Pathol Anat Histopathol. 1989;414:279–84.PubMed

50.

Chung DR, Yang WS, Kim SB, Yu E, Chung YH, Lee Y, et al. Treatment of hepatitis B virus associated glomerulonephritis with recombinant human alpha interferon. Am J Nephrol. 1997;17:112–7.PubMed

51.

Okuse C, Yotsuyanagi H, Yamada N, Ikeda H, Takahashi H, Suzuki M, et al. Successful treatment of hepatitis B virus-associated membranous nephropathy with lamivudine. Clin Nephrol. 2006;65:53–6.PubMed

52.

Tang S, Lai FM-M, Lui YH, CSO T, NNS K, Ho YW, et al. Lamivudine in hepatitis B-associated membranous nephropathy. Kidney Int. 2005;68:1750–8.PubMed

53.

Lin CY. Treatment of hepatitis B virus-associated membranous nephropathy with recombinant alpha-interferon. Kidney Int. 1995;47:225–30.PubMed

54.

Conjeevaram HS, Hoofnagle JH, Austin HA, Park Y, Fried MW, Di Bisceglie AM. Long-term outcome of hepatitis B virus-related glomerulonephritis after therapy with interferon alfa. Gastroenterology. 1995;109:540–6.PubMed

55.

• Wang W, Wu M, Ma F, Sun T, Xu Z. Meta-analysis of the efficacy and safety of nucleotide/nucleoside analog monotherapy for hepatitis B virus-associated glomerulonephritis. Clin Nephrol. 2016;85:21–9. A recent meta-analysis based on ten clinical trials evaluating the efficacy and safety of nucleos(t)ide analogue monotherapy for HBV-related glomerulonephritis. PubMed

56.

Yi Z, Jie YW, Nan Z. The efficacy of anti-viral therapy on hepatitis B virus-associated glomerulonephritis: a systematic review and meta-analysis. Ann Hepatol. 2011;10:165–73.PubMed

57.

• Sun L-J, Shan J-P, Cui R-L, Yuan W-J, Jiang G-R. Combination therapy with lamivudine and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker for hepatitis B virus-associated glomerulonephritis with mild to moderate proteinuria: a clinical review of 38 cases. Int Urol Nephrol 2017 Jun; 49(6):1049–1056. A recent retrospective study exploring the effect of a combination of lamivudine plus angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) or a ACEI/ARB monotherapyon liver function and proteinuria. PubMed

58.

Hollinger FB, DT-Y L. Hepatitis B: the pathway to recovery through treatment. Gastroenterol Clin N Am. 2006;35:895–931.

59.

Wands JR, Mann E, Alpert E, Isselbacher KJ. The pathogenesis of arthritis associated with acute hepatitis-B surface antigen-positive hepatitis. Complement activation and characterization of circulating immune complexes. J Clin Invest. 1975;55:930–6.PubMedPubMedCentral

60.

Michitaka K, Horiike N, Chen Y, Duong TN, Konishi I, Mashiba T, et al. Gianotti-Crosti syndrome caused by acute hepatitis B virus genotype D infection. Intern Med. 2004;43:696–9.PubMed

61.

Ishimaru Y, Ishimaru H, Toda G, Baba K, Mayumi M. An epidemic of infantile papular acrodermatitis (Gianotti’s disease) in Japan associated with hepatitis-B surface antigen subtype ayw. Lancet. 1976;1:707–9.PubMed

62.

Chuh A, Zawar V, Sciallis GF, Kempf W, Lee A. Pityriasis rosea, Gianotti-Crosti syndrome, asymmetric periflexural exanthem, papular-purpuric gloves and socks syndrome, eruptive pseudoangiomatosis, and eruptive hypomelanosis: do their epidemiological data substantiate infectious etiologies? Infect Dis Rep [Internet]. 2016 [cited 2017 Mar 24];8. Available from: http://www.pagepress.org/journals/index.php/idr/article/view/6418

63.

Baleviciené G, Maciuleviciené R, Schwartz RA. Papular acrodermatitis of childhood: the Gianotti-Crosti syndrome. Cutis. 2001;67:291–4.PubMed

64.

Lewis JH, Brandon JM, Gorenc TJ, Maxwell NG. Hepatitis B. A study of 200 cases positive for the hepatitis B antigen. Am J Dig Dis. 1973;18:921–9.PubMed

65.

Steigman AJ. Rashes and arthropathy in viral hepatitis. Mt Sinai J Med. 1973;40:752–7.PubMed

66.

McElgunn PS. Dermatologic manifestations of hepatitis B virus infection. J Am Acad Dermatol. 1983;8:539–48.PubMed

67.

Shumaker JB, Goldfinger SE, Alpert E, Isselbacher KJ. Arthritis and rash. Clues to anicteric viral hepatitis. Arch Intern Med. 1974;133:483–5.PubMed

68.

Niermeijer P, Gips CH. Natural history of acute hepatitis B in previously healthy patients: a prospective study. Acta Hepatogastroenterol (Stuttg). 1977;24:317–25.

69.

Dienstag JL, Rhodes AR, Bhan AK, Dvorak AM, Mihm MC, Wands JR. Urticaria associated with acute viral hepatitis type B: studies of pathogenesis. Ann Intern Med. 1978;89:34–40.PubMed

70.

Dogan B. Dermatological manifestations in hepatitis B surface antigen carriers in east region of Turkey. J Eur Acad Dermatol Venereol. 2005;19:323–5.PubMed

71.

Bokor-Bratic M. Lack of evidence of hepatic disease in patients with oral lichen planus in Serbia. Oral Dis. 2004;10:283–6.PubMed

72.

Löhr H, Goergen B, Weber W, Gödderz W, Meyer zum Büschenfelde KH, Gerken G. Mixed cryoglobulinemia type II in chronic hepatitis B associated with HBe-minus HBV mutant: cellular immune reactions and response to interferon treatment. J Med Virol. 1994;44:330–5.PubMed

73.

Levo Y, Gorevic PD, Kassab HJ, Zucker-Franklin D, Franklin EC. Association between hepatitis B virus and essential mixed cryoglobulinemia. N Engl J Med. 1977;296:1501–4.PubMed

74.

McMahon BJ, Alberts SR, Wainwright RB, Bulkow L, Lanier AP. Hepatitis B-related sequelae. Prospective study in 1400 hepatitis B surface antigen-positive Alaska native carriers. Arch Intern Med. 1990;150:1051–4.PubMed

75.

Yamazaki T, Akimoto T, Okuda K, Sugase T, Takeshima E, Numata A, et al. Purpura with ulcerative skin lesions and mixed cryoglobulinemia in a quiescent hepatitis B virus carrier. Intern Med. 2014;53:115–9.PubMed

76.

Nath A, Agarwal R, Malhotra P, Varma S. Prevalence of hepatitis B virus infection in non-Hodgkin lymphoma: a systematic review and meta-analysis. Intern Med J. 2010;40:633–41.PubMed

77.

•• Engels EA, Cho ER, Jee SH, Hepatitis B. virus infection and risk of non-Hodgkin lymphoma in South Korea: a cohort study. Lancet Oncol. 2010;11:827–34. Large Korean prospective cohort study evaluating the risk of non-Hodgkin lymphoma over 14 years of follow-up among patients with chronic HBV infection. PubMedPubMedCentral

78.

Becker N, Schnitzler P, Boffetta P, Brennan P, Foretova L, Maynadié M, et al. Hepatitis B virus infection and risk of lymphoma: results of a serological analysis within the European case-control study Epilymph. J Cancer Res Clin Oncol. 2012;138:1993–2001.PubMed

79.

Dalia S, Chavez J, Castillo JJ, Sokol L. Hepatitis B infection increases the risk of non-Hodgkin lymphoma: a meta-analysis of observational studies. Leuk Res. 2013;37:1107–15.PubMed

80.

Tsukada N, Koh CS, Inoue A, Yanagisawa N. Demyelinating neuropathy associated with hepatitis B virus infection. Detection of immune complexes composed of hepatitis B virus surface antigen. J Neurol Sci. 1987;77:203–16.PubMed

81.

Ray G, Ghosh B, Bhattacharyya R. Acute Hepatitis B presenting as Guillain-Barré syndrome. Indian J Gastroenterol. 2003;22:228.PubMed

82.

Yimam KK, Merriman RB, Todd Frederick R. A rare case of acute hepatitis B virus infection causing Guillain-Barré syndrome. Gastroenterol Hepatol (N Y). 2013;9:121–3.

83.

McMahon BJ, Helminiak C, Wainwright RB, Bulkow L, Trimble BA, Wainwright K. Frequency of adverse reactions to hepatitis B vaccine in 43,618 persons. Am J Med. 1992;92:254–6.PubMed

84.

Baxter R, Bakshi N, Fireman B, Lewis E, Ray P, Vellozzi C, et al. Lack of association of Guillain-Barre syndrome with vaccinations. Clin Infect Dis. 2013;57:197–204.PubMed

85.

• Pakpoor J, Noyce A, Goldacre R, Selkihova M, Mullin S, Schrag A, et al. Viral hepatitis and Parkinson disease: a national record-linkage study. Neurology. 2017 Apr 25;88(17):1630–1633. A recent retrospective cohort study reporting a significant association between HBV infection and Parkinson disease. PubMed

86.

Grob PJ, Martenet AC, Witmer R. Nonspecific immune parameters and hepatitis B antigens in patients with uveitis. Mod Probl Ophthalmol. 1976;16:254–8.PubMed

87.

Murray PI, Prasad J, Rahi AH. Status of hepatitis B virus in the aetiology of uveitis in Great Britain. Br J Ophthalmol. 1983;67:685–7.PubMedPubMedCentral

88.

Murray PI, Waite J, Rahi AH, Tedder RS. Acute anterior uveitis and hepatitis B virus infection. Br J Ophthalmol. 1984;68:595–7.PubMedPubMedCentral

89.

Cacoub P, Saadoun D, Bourlière M, Khiri H, Martineau A, Benhamou Y, et al. Hepatitis B virus genotypes and extrahepatic manifestations. J Hepatol. 2005;43:764–70.PubMed

Titel: Extrahepatic Manifestations of Chronic Hepatitis B Infection
verfasst von: Victor Virlogeux
Christian Trépo
Publikationsdatum: 13.06.2018
Verlag: Springer US
Erschienen in: Current Hepatology Reports / Ausgabe 3/2018
Elektronische ISSN: 2195-9595
DOI: https://doi.org/10.1007/s11901-018-0403-0

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

25.04.2024 | Hypotonie | Nachrichten

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Extrahepatic Manifestations of Chronic Hepatitis B Infection

Abstract

Purpose of Review

Recent Findings

Summary

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Adjuvante Immuntherapie verlängert Leben bei RCC

Alectinib verbessert krankheitsfreies Überleben bei ALK-positivem NSCLC

Update Innere Medizin

Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2018

Is Exercise Beneficial and Safe in Patients with Cirrhosis and Portal Hypertension?

Uncommon Presentations of Idiosyncratic Drug-Induced Liver Injury

Novel Approaches to Causality Adjudication in Drug-Induced Liver Disease

Management of Autoimmune Hepatitis Patients Refractory to or Intolerant of Standard Therapies

The Portosystemic Shunt Syndrome and Role of Shunt Embolization in the Management of Hepatic Encephalopathy

Drug-induced Liver Injury Associated with Weight Loss Supplements

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Adjuvante Immuntherapie verlängert Leben bei RCC

Alectinib verbessert krankheitsfreies Überleben bei ALK-positivem NSCLC

Update Innere Medizin