The kidney and liver diseases

A review on the medicinal potential, toxicology, and phytochemistry of litchi fruit peel and seed

The perception that many fruit wastes, particularly the peel, contain more phytochemicals than the edible portions has been largely supported by scientific evidence, making them potential sources of bioactive and therapeutic phytochemicals. The peel and seed of Litchi (Litchi chinensis Sonn.) contain bioactive principles and have been shown to exhibit antioxidative, antidiabetic, cancer preventive, anti-obesogenic, and anti-inflammatory properties. This review presents a critical analysis of previous and current perspectives on the medicinal, toxicological, and phytochemical profiles of litchi fruit peel and seed, thus providing an evidence-based platform to explore their medicinal potential. A literature search was done on "PubMed," "Google Scholar," and "ScienceDirect." Peer-reviewed published data on the medicinal profiles of litchi fruit peel and seed were identified and critically analyzed. The fruit peel and seed improved glycemic control and insulin signaling and downregulated lipogenic and cholesterogenic processes. Their neuroprotective, hepatoprotective, and renal protective potentials were influenced by antioxidative and anti-inflammatory actions. The anticancer effect was mediated by upregulated proapoptotic, proinflammatory, antiproliferative, and anti-metastatic processes in cancer cells. Simple flavonols, sesquiterpenes, phenolic acids, jasmonates, and proathocyanidins are the possible bioactive principles influencing the medicinal effects. Appropriate toxicity studies are, however, still lacking. Litchi fruit wastes may be further studied as useful sources of therapeutic agents that may have medicinal relevance in oxidative, metabolic, vascular, and carcinogenic ailments. PRACTICAL APPLICATIONS: Underutilized fruit wastes contribute to environmental pollution. Interestingly, these wastes contain phytochemicals that could be of medicinal relevance if their medicinal potentials are maximized. Litchi fruit is a widely consumed fruit with commercial value. Its peel and seeds contribute to fruit wastes. The review exposes the medicinal potential and bioactive principles and/or nutrients of the fruit's peel and seed while elucidating the underlying therapeutic mechanisms or modes of actions through which litchi peel and seed potentiate medicinal effects. Thus, the review provides an evidence-based platform to explore the medicinal potential of underutilized wastes from litchi fruit. Additionally, the fruit peel and seed could be low-cost residues that could afford ecofriendly opportunity if their medicinal potentials are properly maximized.

Acid-Base and Potassium Disorders in Liver Disease

Acid-base and potassium disorders occur frequently in the setting of liver disease. As the liver's metabolic function worsens, particularly in the setting of renal dysfunction, hemodynamic compromise, and hepatic encephalopathy, acid-base disorders ensue. The most common acid-base disorder is respiratory alkalosis. Metabolic acidosis alone or in combination with respiratory alkalosis also is common. Acid-base disorders in patients with liver disease are complex. The urine anion gap may help to distinguish between chronic respiratory alkalosis and hyperchloremic metabolic acidosis when a blood gas is not available. A negative urine anion gap helps to rule out chronic respiratory alkalosis. In this disorder a positive urine anion gap is expected owing to suppressed urinary acidification. Distal renal tubular acidosis occurs in autoimmune liver disease such as primary biliary cirrhosis, but often is a functional defect from impaired distal sodium delivery. Potassium disorders are often the result of the therapies used to treat advanced liver disease.

Recombinant human gamma-interferon in primary hepatocellular carcinoma

A phase II trial of recombinant human gamma-interferon in the treatment of unresectable primary hepatocellular carcinoma is reported. The trial was terminated prematurely after recruitment of only 7 patients because of unacceptable toxicity, predominantly renal. There was no evidence of response in any of the 7 patients but some evidence that disease progression was more rapid during the treatment period.

The pharmacokinetics and pharmacodynamics of the diuretic bumetanide in hepatic and renal disease

1 Bumetanide (1 mg) was given orally and intravenously to a group of patients with chronic renal failure (n = 6) and to another group with cirrhosis of the liver (n = 8). 2 The pharmacokinetics, using a two-compartment model, and the pharmacodynamics of the drug in these patients were compared with those previously obtained for normal subjects. 3 In the renal group serum bumetanide concentrations were higher than for the normal subjects and the terminal half-lives were significantly prolonged (P less than 0.001). A decreased whole body clearance was attributable to a low renal clearance of drug, the non-renal clearance being significantly increased (P less than 0.01). 4 For the patients with liver disease, serum bumetanide concentrations were higher than for the renal group, and the terminal half-lives were significantly further prolonged (P less than 0.001). Both non-renal and renal clearances were significantly reduced (P less than 0.001). 5 Absorption rates were not significantly altered in either group and the values of F (bioavailability) were 0.82 and 0.95 for the patients with renal disease and hepatic disease, respectively. 6 A poor pharmacodynamic response and a reduced bumetanide excretion rate were observed for the patients with chronic renal failure, whereas with hepatic disease normal bumetanide excretion rates were observed with an impaired diuretic response.