Drug induced liver injury classification: Difference between revisions
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==Overview== | ==Overview== | ||
Drug induced liver injury may be classified into multiple subtypes based on clinical presentation, mechanism, or histologic findings.<ref name="pmid26125428">{{cite journal| author=Fisher K, Vuppalanchi R, Saxena R| title=Drug-Induced Liver Injury. | journal=Arch Pathol Lab Med | year= 2015 | volume= 139 | issue= 7 | pages= 876-87 | pmid=26125428 | doi=10.5858/arpa.2014-0214-RA | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26125428 }} </ref> | |||
==Classification== | ==Classification== | ||
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===Clinical presentation:=== | ===Clinical presentation:=== | ||
====Hepatocellular injury==== | ====Hepatocellular injury==== | ||
* | *Elevation of serum transaminases ≥ 2-5 times the upper limit of normal | ||
* | *May have hyperbilirubinemia | ||
* | *May have abnormal synthetic function tests (e.g. International Normalized Ratio, albumin) | ||
====Cholestatic injury==== | ====Cholestatic injury==== | ||
* | *Elevation of alkaline phosphatase ≥ 3 times the upper limit of normal | ||
* | *May have hyperbilirubinemia | ||
* | *May have abnormal synthetic function tests (e.g. International Normalized Ratio, albumin) | ||
====Mixed injury==== | ====Mixed injury==== | ||
* | *Both alkaline phosphatase and transaminases are elevated in roughly equal proportion, and/or an alanine aminotransferase to alkaline phosphatase ratio between 2-5 | ||
===Mechanism:=== | ===Mechanism:=== | ||
====Dose-dependent hepatotoxicity==== | ====Dose-dependent hepatotoxicity==== | ||
*e.g. | *e.g. Acetaminophen-induced centrilobular necrosis | ||
====Idiosyncratic hepatotoxicity==== | ====Idiosyncratic hepatotoxicity==== | ||
*e.g. | *e.g. Stimulation of immune reponse by biologic agents, independent of dose, akin to drug hypersensitivity | ||
*e.g. | *e.g. Altered host genes involved in drug metabolism | ||
===Histologic findings:=== | ===Histologic findings:=== | ||
Histologic findings may be further subclassified into: | |||
*[[Hepatitis]] (hepatocellular injury) | |||
*[[Cholestasis]] | |||
*[[Granulomatous]] | |||
*[[Steatosis]] | |||
*[[Fibrosis]] | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 19:51, 24 October 2016
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Drug induced liver injury Microchapters |
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Differentiating Drug Induced Liver Injury from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Drug Induced Liver Injury On the Web |
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American Roentgen Ray Society Images of Drug induced liver injury |
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Risk calculators and risk factors for Drug induced liver injury |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rachita Navara, M.D. [2]
Overview
Drug induced liver injury may be classified into multiple subtypes based on clinical presentation, mechanism, or histologic findings.[1]
Classification
Drug induced liver injury may be classified into multiple subtypes based on clinical presentation, mechanism, or histologic findings.
Clinical presentation:
Hepatocellular injury
- Elevation of serum transaminases ≥ 2-5 times the upper limit of normal
- May have hyperbilirubinemia
- May have abnormal synthetic function tests (e.g. International Normalized Ratio, albumin)
Cholestatic injury
- Elevation of alkaline phosphatase ≥ 3 times the upper limit of normal
- May have hyperbilirubinemia
- May have abnormal synthetic function tests (e.g. International Normalized Ratio, albumin)
Mixed injury
- Both alkaline phosphatase and transaminases are elevated in roughly equal proportion, and/or an alanine aminotransferase to alkaline phosphatase ratio between 2-5
Mechanism:
Dose-dependent hepatotoxicity
- e.g. Acetaminophen-induced centrilobular necrosis
Idiosyncratic hepatotoxicity
- e.g. Stimulation of immune reponse by biologic agents, independent of dose, akin to drug hypersensitivity
- e.g. Altered host genes involved in drug metabolism
Histologic findings:
Histologic findings may be further subclassified into:
- Hepatitis (hepatocellular injury)
- Cholestasis
- Granulomatous
- Steatosis
- Fibrosis
References
- ↑ Fisher K, Vuppalanchi R, Saxena R (2015). "Drug-Induced Liver Injury". Arch Pathol Lab Med. 139 (7): 876–87. doi:10.5858/arpa.2014-0214-RA. PMID 26125428.