Figure 127

Evaluation of patients with signs and symptoms of liver disease. Patients with cholecystitis should be considered for cholecystectomy. For other patients with signs and symptoms of liver disease, potential hepatic toxins should be considered. The incidence of liver disease from iron deposition has declined with the diminishing use of blood transfusions in dialysis patients, but may be seen occasionally in patients with a high total iron binding capacity (TIBC) or ferritin. All prospective candidates for transplantation must be screened for hepatitis B and C by testing for the presence of hepatitis B surface antigen (HBsAg) and hepatitis C virus (HCV) antibodies. Both viruses can cause potentially fatal liver disease after transplantation. Fortunately, the incidence of hepatitis B is declining among patients with renal disease, largely as a result of the use of effective vaccination programs. (From Kasiske and coworkers [1]; with permission.)

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