Antoniv A. A., Antoniv N. A.

MORPHOLOGICAL FEATURES OF LIVER INJURY IN METABOLIC DYSFUNCTION-ASSOCIATED STEATOHEPATITIS WITH COMORBID CHRONIC KIDNEY DISEASE

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About the author:

Antoniv A. A., Antoniv N. A.

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CLINICAL AND EXPERIMENTAL MEDICINE

Type of article:

Scientific article

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Direct biopsy comparisons of metabolic dysfunction-associated steatohepatitis (MASH) according to chronic kidney disease (CKD) status remain limited. The aim of this study was to compare liver morphology in pa- tients with MASH with and without stage I–III CKD. Sixty patients aged 35–57 years with MASH and class I obesity were included. Thirty patients had no CKD, whereas 30 had stage I–III CKD associated with chronic complicated pyelonephritis. Three liver biopsy cores from separate areas of segments V and VII were examined for each participant. Steatosis grade and acinar distribution, microvesicular steatosis, lobular and portal inflammation, hepatocellular degenerative changes, and fibrosis were assessed according to the E.M. Brunt criteria. The patient, rather than each biopsy fragment, was the statistical unit. Group frequencies were compared using Pearson’s chi-square test; odds ratios and 95% confidence intervals were calculated. S2–S3 steatosis was identified in 97% of patients with CKD and 53% of those without CKD (p=0.0001). Panacinar steatosis occurred in 50% versus 20% (p=0.0149), and a microvesicular component in 83% versus 40% (p=0.0006). Lobular inflammation exceeding four foci per field was recorded in 43% versus 10% (p=0.0035), while moderate or marked portal inflammation occurred in 67% versus 30% (p=0.0045). Multiple hepatocellular degenerative changes were present in 77% of patients with CKD and 40% without CKD (p=0.0040); multiple glycogenated nuclei were observed in 50% and 20%, respectively (p=0.0149). F2-F3 fibrosis was found in 47% of the CKD group and 23% of the non-CKD group, but the difference was not statistically significant (p=0.0581); F4 fibrosis was absent. Thus, in this cohort, stage I-III CKD accompanying MASH was associated with a broader steatotic pattern, greater lobular and portal inflammatory activity, and more extensive hepatocellular degeneration. The fibrosis finding remained numerical rather than statistically confirmed and should not be interpreted as evidence of faster fibrogenesis.

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Publication of the article:

«Bulletin of problems biology and medicine», 2026 Issue 3, 182, 205-210 pages, index UDC 616.36-003.826:616.61-036.12

DOI:

10.29254/2077-4214-2026-3-182-205-210