Fine Needle Aspirative Biopsy of the Liver in HBsAG-Positive Patients with End-Stage Renal Failure

Abstract

HBsAg-positive patients with end-stage renal failure have a high prevalence of asymptomatic chronic hepatitis. In order to determine the usefulness of hepatic cytology in the diagnosis of liver disease, the findings of hepatic needle core biopsy (NCB) and fine needle aspirative biopsy (FNAB) were compared in 75 HBsAg-positive uremic patients. The patients, aged 42 ± 12 years, 14 males, were on hemodialysis for periods ranging from 13 to 105 months. The NCB was processed by standard histologic and immunohis-tochemical techniques and FNAB by the conventional technique, using the total corrected increment score (TCI). Plasma samples were collected for evaluation of hepatic function and for viral serologic tests. In 15 patients a diagnosis was made by NCB: normal, 7 cases; chronic persistent hepatitis, 4 cases', and chronic active hepatitis, 4 cases. When the patients were allocated into two groups according to the severity of the liver histologic findings [group I—minor changes (normal + chronic persistent hepatitis), 11 patients; group II—major changes (chronic active hepatitis), 4 patients], statistically higher values were found in the major changes group for alanine aminotransferase (49 ± 33 vs. 24 ± 11, p = 0.04), γ-glutamyl transpeptidase [148 ± 53 vs. 38 ± 28, p<(minor) 0.02] and TCI (3.7 ± 1.2 vs. 2.5 ± 0.8, p = 0.04). In conclusion, liver FNAB can be useful as a screening procedure for the identification of liver histologic changes (minor or major) in uremic HBsAG-positive patients.

Key Words:

• Chronic hepatic disease
• End-stage renal failure
• Hemodialysis
• Hepatitis B