Drug induced liver injury:

Do we still need a routine liver biopsy for diagnosis today? 

Autores: Teschke Rolf, Frenzel Christian

Resumen

For the pathologist, the diagnosis of drug induced liver injury (DILI) is challenging, because histopathological features mimic all primary hepatic and biliary diseases, lacking changes that are specific for DILI. Therefore, in any patient of suspected DILI who underwent liver biopsy, the pathologist will assure the clinician that the observed hepatic changes are compatible with DILI, but this information is less helpful due to lack of specificity. Rather, the pathologist should assess liver biopsies blindly, without knowledge of prior treatment by drugs. This will result in a detailed description of the histological findings, associated with suggestions for potential causes of these hepatic changes. Then, it is up to the physician to reassess carefully the differential diagnoses, if not done before. At present, liver histology is of little impact establishing the diagnosis of DILI with the required degree of certainty, and this shortcoming also applies to herb induced liver injury (HILI). To reach at the correct diagnoses of DILI and HILI, clinical and structured causality assessments are therefore better approaches than liver histology results obtained through liver biopsy, an invasive procedure with a low complication rate.

Palabras clave: Drug induced liver injury. Drug hepatotoxicity. Herb induced liver injury. Liver biopsy. Liver histology.

2014-03-01   |   236 visitas   |   1 valoraciones

Vol. 13 Núm.1. Enero-Febrero 2014 Pags. 121-126 Ann Hepatol 2014; 13(1)