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HEPATIC FAILURE and SPIRONOLACTONE

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HEPATIC FAILURE Symptoms and Causes

What is fatty liver disease?

Your liver is the largest organ inside your body. It helps your body digest food, store energy, and remove poisons. Fatty liver disease is a condition in which fat builds up in your liver. There are two main types:

  • Nonalcoholic fatty liver disease (NAFLD)
  • Alcoholic fatty liver disease, also called alcoholic steatohepatitis
What is nonalcoholic fatty liver disease (NAFLD)?

NAFLD is a type of fatty liver disease that is not related to heavy alcohol use. There are two kinds:

  • Simple fatty liver, in which you have fat in your liver but little or no inflammation or liver cell damage. Simple fatty liver typically does not get bad enough to cause liver damage or complications.
  • Nonalcoholic steatohepatitis (NASH), in which you have inflammation and liver cell damage, as well as fat in your liver. Inflammation and liver cell damage can cause fibrosis, or scarring, of the liver. NASH may lead to cirrhosis or liver cancer.
What is alcoholic fatty liver disease?

Alcoholic fatty liver disease is due to heavy alcohol use. Your liver breaks down most of the alcohol you drink, so it can be removed from your body. But the process of breaking it down can generate harmful substances. These substances can damage liver cells, promote inflammation, and weaken your body's natural defenses. The more alcohol that you drink, the more you damage your liver. Alcoholic fatty liver disease is the earliest stage of alcohol-related liver disease. The next stages are alcoholic hepatitis and cirrhosis.

Who gets fatty liver disease?

Researchers do not know the cause of nonalcoholic fatty liver (NAFLD). They do know that it is more common in people who

  • Have type 2 diabetes and prediabetes
  • Are obese
  • Are middle aged or older (although children can also get it)
  • Are Hispanic, followed by non-Hispanic whites. It is less common in African Americans.
  • Have high levels of fats in the blood, such as cholesterol and triglycerides
  • Have high blood pressure
  • Take certain drugs, such as corticosteroids and some cancer drugs
  • Have certain metabolic disorders, including metabolic syndrome
  • Have rapid weight loss
  • Have certain infections, such as hepatitis C
  • Have been exposed to some toxins

NAFLD affects about 25 percent of people in the world. As the rates of obesity, type 2 diabetes, and high cholesterol are rising in the United States, so is the rate of NAFLD. NAFLD is the most common chronic liver disorder in the United States.

Alcoholic fatty liver disease only happens in people who are heavy drinkers, especially those who have been drinking for a long period of time. The risk is higher for heavy drinkers who are women, are obese, or have certain genetic mutations.

What are the symptoms of fatty liver disease?

Both NAFLD and alcoholic fatty liver disease are usually silent diseases with few or no symptoms. If you do have symptoms, you may feel tired or have discomfort in the upper right side of your abdomen.

How do I know if I have fatty liver disease?

Because there are often no symptoms, it is not easy to find fatty liver disease. Your doctor may suspect that you have it if you get abnormal results on liver tests that you had for other reasons. To make a diagnosis, your doctor will use

  • Your medical history
  • A physical exam
  • Various tests, including blood and imaging tests, and sometimes a biopsy

As part of the medical history, your doctor will ask about your alcohol use, to find out whether fat in your liver is a sign of alcoholic fatty liver disease or nonalcoholic fatty liver (NAFLD). He or she will also ask which medicines you take, to try to determine whether a medicine is causing your NAFLD.

During the physical exam, your doctor will examine your body and check your weight and height. Your doctor will look for signs of fatty liver disease, such as

  • An enlarged liver
  • Signs of cirrhosis, such as jaundice, a condition that causes your skin and whites of your eyes to turn yellow

You will likely have blood tests, including liver function tests and blood count tests. In some cases you may also have imaging tests, like those that check for fat in the liver and the stiffness of your liver. Liver stiffness can mean fibrosis, which is scarring of the liver. In some cases you may also need a liver biopsy to confirm the diagnosis, and to check how bad the liver damage is.

What are the treatments for fatty liver disease?

Doctors recommend weight loss for nonalcoholic fatty liver. Weight loss can reduce fat in the liver, inflammation, and fibrosis. If your doctor thinks that a certain medicine is the cause of your NAFLD, you should stop taking that medicine. But check with your doctor before stopping the medicine. You may need to get off the medicine gradually, and you might need to switch to another medicine instead.

There are no medicines that have been approved to treat NAFLD. Studies are investigating whether a certain diabetes medicine or Vitamin E can help, but more studies are needed.

The most important part of treating alcohol-related fatty liver disease is to stop drinking alcohol. If you need help doing that, you may want to see a therapist or participate in an alcohol recovery program. There are also medicines that can help, either by reducing your cravings or making you feel sick if you drink alcohol.

Both alcoholic fatty liver disease and one type of nonalcoholic fatty liver disease (nonalcoholic steatohepatitis) can lead to cirrhosis. Doctors can treat the health problems caused by cirrhosis with medicines, operations, and other medical procedures. If the cirrhosis leads to liver failure, you may need a liver transplant.

What are some lifestyle changes that can help with fatty liver disease?

If you have any of the types of fatty liver disease, there are some lifestyle changes that can help:

  • Eat a healthy diet, limiting salt and sugar, plus eating lots of fruits, vegetables, and whole grains
  • Get vaccinations for hepatitis A and B, the flu and pneumococcal disease. If you get hepatitis A or B along with fatty liver, it is more likely to lead to liver failure. People with chronic liver disease are more likely to get infections, so the other two vaccinations are also important.
  • Get regular exercise, which can help you lose weight and reduce fat in the liver
  • Talk with your doctor before using dietary supplements, such as vitamins, or any complementary or alternative medicines or medical practices. Some herbal remedies can damage your liver.

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SPIRONOLACTONE Side Effects

Hyperkalaemia (208)
Renal Failure Acute (103)
Dyspnoea (81)
Dehydration (59)
Asthenia (56)
Gynaecomastia (55)
Diarrhoea (52)
Nausea (50)
Blood Potassium Increased (50)
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Syncope (16)
Pneumonia (16)
Myocardial Infarction (16)
Oedema (15)

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HEPATIC FAILURE Clinical Trials and Studies

Treatments might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. The goal of clinical trials is to determine if a new test or treatment works and is safe. Clinical trials can also look at other aspects of care, such as improving the quality of life for people with chronic illnesses. People participate in clinical trials for a variety of reasons. Healthy volunteers say they participate to help others and to contribute to moving science forward. Participants with an illness or disease also participate to help others, but also to possibly receive the newest treatment and to have the additional care and attention from the clinical trial staff.
Rank Status Study
1 Recruiting Effects of Spironolactone on Collagen Metabolism in Patients With Pulmonary Arterial Hypertension
Condition: Pulmonary Hypertension
Interventions: Drug: Spironolactone;   Drug: Placebo
Outcome Measures: Change in biomarker levels in the Spironolactone treated as compared to placebo treated group.;   Number of adverse events in patients treated with Spironolactone as compared to placebo.;   Change in six-minute walk distance from baseline to week 8 and week 16.;   Composite end-point
2 Recruiting Acetazolamide and Spironolactone to Increase Natriuresis in Congestive Heart Failure
Condition: Heart Failure
Interventions: Drug: Combination therapy with acetazolamide and low-dose loop diuretics;   Drug: High-dose loop diuretics;   Drug: Upfront therapy with oral Spironolactone
Outcome Measures: Acetazolamide arm: natriuresis 24 h;   Spironolactone arm: incidence of hypo- (serum potassium <3.5 mmol/L) or hyperkalemia (serum potassium >5.0 mmol/L);   NT-proBNP change after 72 h;   Worsening renal function;   Persistent renal impairment;   Peak plasma aldosterone concentration after 72 h;   Peak plasma renin activity after 72 h
3 Recruiting Determining the Effect of Spironolactone on Electrolyte Supplementation in Preterm Infants With Chronic Lung Disease
Conditions: Chronic Lung Disease;   Bronchopulmonary Dysplasia
Interventions: Drug: Spironolactone;   Drug: Placebo
Outcome Measures: Dose of potassium chloride in milliequivalents/kg/day;   Requirement of electrolyte supplementation;   Analyze the use of furosemide rescue doses;   Number of furosemide doses utilized;   Escalation in respiratory support
4 Unknown  Effects of Spironolactone in Dialysis
Condition: Renal Failure
Intervention: Drug: Spironolactone
Outcome Measures: Reduction of Left Ventricular Hypertrophy;   To evaluate the safety and efficacy of the use of Spironolactone at a dose of 25mg in patients with chronic kidney disease on hemodialysis.
5 Unknown  Spironolactone for Paroxysmal Atrial Fibrillation
Condition: Atrial Fibrillation
Interventions: Drug: Spironolactone;   Drug: Placebo
Outcome Measures: time to a first electrocardiographically confirmed AF;   1. Response rate: Improvement of any symptom scores and/or SF36 scores more than 50 % (compared with re-randomization scores) 2. Difference of mean episodes of documented AF between the Spironolactone and placebo groups.
6 Not yet recruiting L-Arginine and Spironolactone Trial in Dialysis-Dependent ESRD
Conditions: End Stage Renal Disease;   Hemodialysis
Interventions: Drug: Spironolactone;   Dietary Supplement: L-arginine;   Drug: Placebo
Outcome Measures: Change in coronary Flow Reserve (PET);   Change in left ventricular diastolic function;   Association between coronary flow reserve (CFR) and tissue doppler index (E');   Change in resting myocardial blood flow;   Change in left ventricular mass index;   Change in coronary vascular resistance;   Association between change in coronary flow reserve (CFR) and change in diastolic function-tissue doppler index (E');   Change in early diastolic function (E');   Combined cardiovascular safety;   Cardiovascular death;   Hyperkalemia;   Hypotension;   Change in early coronary flow reserve;   Change in hyperemic myocardial blood flow
7 Recruiting The Effect of Spironolactone on Pain in Older People With Osteoarthritis
Condition: Osteoarthritis, Knee
Intervention: Drug: Spironolactone
Outcome Measures: Between group difference in change in WOMAC pain subscale (5 items);   Between group difference in change in WOMAC stiffness subscale.
8 Unknown  Effect of Spironolactone on Adrenal or Ovarian Androgen Production in Overweight Pubertal Girls With Androgen Excess
Conditions: Obesity;   Hyperandrogenemia;   Polycystic Ovary Syndrome
Interventions: Drug: Spironolactone;   Drug: Dexamethasone;   Drug: Cosyntropin;   Drug: r-hCG (Ovidrel)
Outcome Measures: Changes in free testosterone and 17 OH progesterone levels after ACTH and r-hCG administration respectively, before and after Spironolactone administration for 12 weeks;   Changes in adrenal and ovarian steroid precursors after ACTH and r-hCG; body composition via air displacement plethysmography, BMI, and glucose tolerance testing results; baseline and after 12 weeks of Spironolactone administration
9 Recruiting Use of Spironolactone for the Prevention of Electrolyte Abnormalities in Patients Treated With Amphotericin B
Condition: Patients With Indications for AmB Treatment
Interventions: Drug: Spironolactone 100mg;   Drug: Spironolactone 200mg;   Drug: Placebo
Outcome Measures: Incidence of hypokalemia ≤3.5mEq/L;   Average potassium supplementation;   Incidence of hyperkalemia;   Acute kidney injury;   Incidence of renal tubular damage;   Incidence of hypomagnesemia
10 Unknown  Effect of Spironolactone in Treating Chronic Non-resolutive Central Serous Chorioretinitis
Condition: Central Serous Chorioretinitis
Interventions: Drug: Spironolactone;   Drug: Placebo
Outcome Measure: Change in Central macular thickness
11 Recruiting Spironolactone in Adult Congenital Heart Disease
Conditions: Congenital Heart Disease;   Heart Failure;   Endomyocardial Fibrosis
Interventions: Drug: Spironolactone;   Other: Placebo
Outcome Measures: "Fibrosis Index" or the volume of distribution of gadolinium in the myocardium measured by MRI.;   PCIIINP, PCINP, MMP-2, TIMP-1, 6-minute walk distance, ejection fraction, and degree of diastolic function
12 Unknown  Addition of Spironolactone in Patients With Resistant Arterial Hypertension
Condition: Hypertension
Intervention: Drug: Spironolactone
Outcome Measures: Average daytime systolic and diastolic blodd pressure evaluated by ABPM (ambulatory blood pressure monitoring);   changes of serum potassium, natrium, creatinine, body weight, casual blood pressure in office, treatment response for different baseline levels of aldosterone and aldosterone/PRA ratio
13 Recruiting Comparison of Effects of Eplerenone Versus Spironolactone in Heart Failure Patients With Glucose Intolerance or Type 2 Diabetes
Conditions: Heart Failure;   Type 2 Diabetes;   Glucose Intolerance
Interventions: Drug: Eplerenone;   Drug: Spironolactone
Outcome Measures: Glycated hemoglobin;   Fasting glucose and lipid profile;   Plasma insulin;   Cortisol;   Adiponectin;   NT-proBNP;   PIIINP
14 Unknown  Efficacy of Therapy With the Spironolactone Pills Compared to Minoxidil Lotion in Female Pattern Hair Loss
Condition: Female Pattern Hair Loss
Interventions: Drug: Spironolactone;   Drug: Minoxidil
Outcome Measures: hair density;   percentage of subjects who experience side effects;   subject assessment of treatment effect
15 Recruiting Spironolactone for Pulmonary Arterial Hypertension
Condition: Pulmonary Arterial Hypertension
Interventions: Drug: Spironolactone;   Drug: Placebo
Outcome Measures: Change in placebo corrected 6-minute walk distance;   Clinical worsening;   Change in placebo corrected VO2 max;   Change in right ventricular function;   Biomarkers of vascular inflammation;   Rate of study drug discontinuation due to hyperkalemia, renal insufficiency, or other side effects such as breast pain and gynecomastia
16 Recruiting Mineralocorticoid Receptor Antagonists in End Stage Renal Disease
Condition: End Stage Renal Disease / Hemodialysis
Intervention: Drug: Spironolactone
Outcome Measures: Left Ventricular Mass Index;   Cardiac function parameters;   Office and 24h blood pressure;   Clinical measures of heart failure severity;   Vascular function;   Biomarkers of heart failure, inflammation and fibrosis;   Quality of Life;   Cardiac death and/or hospitalization for heart failure;   Safety measures
17 Recruiting ALdosterone Antagonist Chronic HEModialysis Interventional Survival Trial
Condition: End Stage Renal Failure on Dialysis
Interventions: Drug: Spironolactone;   Drug: Placebo
Outcome Measures: The time to onset of the first incident :non-fatal MI or hospitalization for heart failure or nonfatal stroke or cardiovascular (CV) death;   The cumulate rate of nonfatal MI, hospitalization for heart failure, nonfatal stroke or CV death;   The time to onset of death from i) any cause and ii) from a CV event and iii) from a non CV cause;   The time of survival without a major CV event (nonfatal MI, hospitalization for heart failure, non-fatal stroke, cardiac arrest resuscitation);   Incidence of procedures related to stenosis or vascular access thrombosis for hemodialysis (HD);   Incidence of coronary or peripheral revascularizations (including lower limb amputations);   Blood pressure and its inter visit variability;   The occurrence of atrial fibrillation;   Incidence of hyperkalemia> 6 mmol/l;   Estimation of the effect of treatment on quality of life.
18 Recruiting Proteomic Prediction and Renin Angiotensin Aldosterone System Inhibition Prevention Of Early Diabetic nephRopathy In TYpe 2 Diabetic Patients With Normoalbuminuria
Conditions: Diabetic Nephropathy;   Diabetic Retinopathy
Interventions: Drug: Spironolactone;   Drug: Placebo;   Drug: Standard care
Outcome Measures: Albuminuria;   Cardiovascular disease and mortality;   Retinopathy;   Change in albuminuria;   Microalbuminuria;   Macroalbuminuria;   Change in CKD class;   Slope of estimated GFR
19 Unknown  Clinical and Therapeutic Implications of Fibrosis in Hypertrophic Cardiomyopathy
Conditions: Myocardial Fibrosis;   Hypertrophic Cardiomyopathy
Intervention: Drug: Spironolactone
Outcome Measures: changes in serum markers of collagen turnover;   measures of diastolic function by echocardiography;   cardiac mass and fibrosis by cardiac magnetic resonance imaging (CMR);   exercise tolerance by exercise VO2max and Holter
20 Unknown  Cardiovascular Protective Effect of Spironolactone in Hemodialysis
Condition: Hemodialysis
Intervention: Drug: Spironolactone (drug)
Outcome Measure: