Figure 79

Liver disease among anti-HCV-positive dialysis patients. Serum alanine aminotransferase levels are elevated in only 24% to 67% of dialysis patients who test positive for the anti-hepatitis C virus (HCV) [80]. Caramelo and colleagues [81] evaluated liver biopsies from 33 patients on hemodialysis who tested positive using ELISA-2 and found a variety of histologic patterns; however, over 50% of these patients had chronic hepatitis or cirrhosis. No correlation has been found between mean levels of serum aminotransferase and severity of liver disease [81]. At this time, liver biopsy is the only reliable method to determine the extent of hepatic injury in patients with end-stage renal disease infected with HCV. Liver function tests and HCV serology testing may help identify patients who are at risk for liver disease. However, a liver biopsy should be obtained before initiating therapy or as part of the evaluation before transplantation. Liver biopsy can identify patients with advanced histologic liver injury who may not be good candidates for transplantation or can be used as a baseline before starting a-interferon therapy. (From Caramelo and colleagues [81]; with permission.)

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