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Renal diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Acute fatty liver of pregnancy (AFLP) is not a common complication of pregnancy, but represents an obstetric emergency of the third trimester (70,71). The patients present with abdominal pain, nausea, vomiting, headache, malaise, anorexia, jaundice, and rarely with hepatic encephalopathy. The etiology could be related to a familial genetic defect in fatty acid metabolism (70). Up to 90% of the women with AFLP can develop ARF (70). Disseminated intravascular coagulopathy is usually present. Serum transaminases are generally not as severely elevated as they are in hepatitis. Most patients with renal failure have evidence of decreased renal perfusion similar to hepatorenal syndrome or acute tubular necrosis. Treatment again involves delivery of the baby.
The liver, gallbladder and pancreas
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Dina G. Tiniakos, Alastair D. Burt
A condition that is histologically similar to alcohol-related steatosis and steatohepatitis is increasingly encountered in obese patients; in such patient populations, there is a high incidence of type 2 diabetes mellitus and other features of the metabolic syndrome, a constellation of disorders related to adverse cardiovascular outcomes. Patients are usually discovered to have abnormal liver function tests, after blood testing for complaints of liver tenderness or tiredness without markers of other liver disease (viral, autoimmune, or drug induced). On imaging, they have evidence of fatty liver (‘bright liver’ on ultrasound). The underlying pathogenesis is thought to be related to an insulin-resistant state with oversupply of fatty acids, coupled with altered fatty acid metabolism. The accumulation of triglycerides in the fat droplets, leading to steatosis, is now considered an adaptive protective response, whereas lipotoxic metabolites of hepatocellular free fatty acids are considered major players in inducing steatohepatitis, the progressive form of non-alcoholic fatty liver disease that may lead to cirrhosis (Figure 11.11). Steatosis usually has a benign course but there are now well-documented instances of slow progression to cirrhosis. The importance of the condition is its increasing prevalence related to the obesity ‘epidemic’, its relationship to treatable or preventable conditions such as diabetes and obesity, and the necessity to ensure that patients are not falsely accused of secret excessive alcohol consumption and the attendant stigma associated with it.
An Overview of the Biological Actions and Neuroendocrine Regulation of Growth Hormone
Published in George H. Gass, Harold M. Kaplan, Handbook of Endocrinology, 2020
Growth hormone is a potent diabetogenic agent, producing hyperglycemia and an insensitivity to elevated levels of insulin, which results from decreased uptake and utilization of carbohydrate. These changes have been observed after administration of growth hormone or after endogenous secretion of growth hormone. Early studies by Weil44 described the response of organisms to exogenous growth hormone as triphasic. Initially, there is a transient hypoglycemia which may be attributed to an increase in fatty acid metabolism. In the second phase, glycolysis and glycogenesis are inhibited due to feedback by the degradation products of fatty acid metabolism and therefore the concentration of glucose in the circulation begins to rise. In the third phase, the increased concentrations of glucose are magnified due to decreased uptake, resulting in a marked release of insulin.
Effects of high-dose L-carnitine supplementation on diaphragmatic function in patients with respiratory failure: A randomized clinical trial
Published in Egyptian Journal of Anaesthesia, 2023
Waleed Abdalla, Mona A. Ammar, Asmaa Ali, Dina Ragab, Mohamed Taeimah
Carnitine is a nutrient essential for the metabolism of fatty acids and their conversion into energy. The primary physiological function of L-carnitine is to move long-chain fatty acids from the cytoplasm to the mitochondrial matrix, where they can be B oxidized[1]. Adequate intracellular carnitine concentrations are vital for optimal fatty acid metabolism in the human body, which uses fatty acids as an energy source. The highest levels of L-carnitine are seen in the skeletal muscles and myocardium[2]. Previous research has shown that L-carnitine supplements improve muscle performance. Nearly two-thirds of hemodialysis patients who experienced cramps, pain, or muscle weakness reported at least some improvement in their symptoms after L-carnitine treatment[3]. L-carnitine has also been found to increase low left ventricular ejection fraction (LVEF) in hemodialysis patients with cardiac morbidity[4]. Studies have also demonstrated that L-carnitine can enhance muscle performance and exercise capacity in athletes [5,6]. Jones et al. assessed the impact of small, medium, and large dose L-carnitine supplementation on organ function in septic shock. [7]
Immunostimulatory effects of vitamin B5 improve anticancer immunotherapy
Published in OncoImmunology, 2022
Melanie Bourgin, Oliver Kepp, Guido Kroemer
Vitamin B5 (pantothenic acid) has recently joined the club of immunostimulatory B vitamins. Vitamin B5 is a precursor of coenzyme A (CoA), an essential cofactor for energy metabolism and fatty acid oxidation.20 CoA can be conjugated to acetate to form acetyl-CoA thioester, which plays a central role in the intersection between amino acid catabolism, glycolysis, fatty acid metabolism, as well as a donor of acetyl groups for acetylation reactions,21 and longer acyl-CoA derivatives, which serve as “activated” fatty acids to participate in intracellular fatty acid transport and lipid biosynthesis.22,23 Of note, a protective effect has been ascribed to vitamin B5 in the context of infection by Plasmodium falciparum, the pathogen responsible for malaria.24 Similarly, vitamin B5 supplementation of mice can afford protection against Mycobacterium tuberculosis, the infectious agent causing tuberculosis, through improved T cell-mediated immunity.25
Serum free fatty acid elevation is related to acute kidney injury in primary nephrotic syndrome
Published in Renal Failure, 2022
Lili Zhang, Li Cui, Chunmei Li, Xiangzhong Zhao, Xiaoying Lai, Jing Li, Teng Lv
FFAs are produced by hydrolysis of triglycerides. As metabolites, fatty acids play a powerful intermediary role in many biological processes. As a key component of phospholipids and glycolipids, fatty acids are important fuel molecules in cell structure and function. Under fasting conditions, fatty acids can also provide energy for cells [25–27]. Abnormal fatty acid metabolism may lead to abnormal pathological metabolic conditions, such as hyperthyroidism, severe liver dysfunction, obesity, insulin resistance and type 2 diabetes mellitus [28–33]. Such abnormalities of serum lipids and lipoproteins in NS are due to impaired clearance and altered biosynthesis [34]. In response to hypoproteinemia, the liver increases not only albumin formation but also lipid production [35,36]; thus, elevated serum lipid levels, including FFA levels, are closely related to decreased albumin levels in patients with NS. However, patients and animals with advanced CKD without nephrosis-range proteinuria also exhibit hypertriglyceridemia and elevated FFA levels [34], which suggests that increased FFA may be one of the manifestations of renal insufficiency rather than the result of decreased albumin. Indeed, a lack of albumin, which can act as an acceptor and carrier of FFA, may diminish intravascular lipolysis and reduce plasma FFA concentrations [37,38]. Therefore, an increase in FFA level can be used as an independent predictor for AKI in NS patients.