A case of alcohol-related liver cirrhosis diagnosed with thrombotic microangiopathy by renal biopsy

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  • Nakamura Yoshiko
    Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine
  • Tokumoto Yoshio
    Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine
  • Yano Ryo
    Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine
  • Sunago Kotaro
    Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine
  • Yukimoto Atsushi
    Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine
  • Tanaka Takaaki
    Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine
  • Watanabe Takao
    Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine
  • Koizumi Yohei
    Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine
  • Yoshida Osamu
    Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine
  • Hirooka Masashi
    Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine
  • Takeshita Eiji
    Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine
  • Abe Masanori
    Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine
  • Miyoshi Ken-Ichi
    Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine
  • Matsuura Bunzo
    Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine
  • Hiasa Yoichi
    Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine

Bibliographic Information

Other Title
  • 血栓性微小血管障害症を合併したアルコール性肝硬変の一例
  • ケッセンセイ ビショウ ケッカン ショウガイショウ オ ガッペイ シタ アルコールセイ カンコウヘン ノ イチレイ

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Abstract

<p>A 70-year-old male with alcohol-related liver cirrhosis was admitted with alcoholic hepatitis. Laboratory data indicated nephrotic syndrome with hematuria. Proteinuria was resolved after alcohol abstinence and treatment with diuretics and nutrition therapy. A renal biopsy performed for hematuria demonstrated thrombotic microangiopathy (TMA) showing numerous deposits and endothelial cell dysfunction. The patient was diagnosed with TMA associated with alcoholic liver disease, along with a decreased ADAMTS13 activity and an increased serum level of von Willebrand factor (VWF). Fresh frozen plasma was transfused for the supplementation of ADAMTS13, and recombinant thrombomodulin products (rTM) were administered for thrombolysis. Cases of hematuria with a decreased ADAMTS13 activity or an imbalance in VWF warrant suspicion of TMA, and FFP/rTM should be considered in patients with cirrhosis.</p>

Journal

  • Kanzo

    Kanzo 63 (11), 473-481, 2022-11-01

    The Japan Society of Hepatology

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