Diagnosis and management of renal dysfunction in patients with cirrhosis.

Diagnosis and management of renal dysfunction in patients with cirrhosis. Expert Rev Gastroenterol Hepatol. 2019 Dec 23;: Authors: Carrion AF, Radhakrishnan R, Martin P Abstract Introduction:Care of patients with sarcoidosis requires familiarity with its natural history as well as various immunosuppressants employed in its treatment.  We would like to share our approach to management based on our experience and understanding of the relevant literature.Areas covered:Asymptomatic patients with pulmonary sarcoidosis ought to be managed conservatively. Systemic sarcoidosis with burdensome symptoms usually responds to corticosteroids, but one needs to consider the risk of long-term steroid toxicity as well as relapse. Rapidly tapering steroids decreases cumulative exposure without compromising efficacy. Steroid sparing anti-sarcoidosis (SSAS) agents take longer to act and are associated with unique but mostly reversible toxicities. Used judiciously and with careful monitoring, they effectively suppress granulomatous inflammation. Patients intolerant of or failing to improve with a particular drug can be switched to another, and occasionally combination therapy with two SSAS agents might prove effective. A small proportion of patients are refractory, but often achieve control and sometimes remission with stepping up to biologic therapy.Expert opinion:Adopting a strategy of early SSAS therapy ought to effectively control sarcoidosis and av...
Source: Expert Review of Gastroenterology and Hepatology - Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research