PMC5762939_01
Schema for the CKD Optimal Management with Binders and NicotinamidE (COMBINE) study.
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The COMBINE study is an ongoing pilot trial testing whether NAM combined with lanthanum carbonate on a background of reduced dietary phosphate intake safely reduces serum phosphate and FGF23 levels over 12 months in 205 patients with stages 3 to 4 CKD (Figure 1).
Portal tract showing a mild inflammatory infiltrate. The inflammation is confined to the portal tract; there is no interface hepatitis that is expected to be seen in chronic hepatitis.
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A liver biopsy showed mild portal inflammation, mainly composed of lymphocytes, occasional plasma cells, and eosinophils (Figure 2, Figure 3, Figure 4).
Portal tract showing mild inflammatory infiltrate.
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A liver biopsy showed mild portal inflammation, mainly composed of lymphocytes, occasional plasma cells, and eosinophils (Figure 2, Figure 3, Figure 4).
Portal tract with inflammatory infiltrate, consisting of lymphocytes, rare plasma cells, and scattered eosinophils. There are small proliferating ductules (ductular reaction), suggestive of some damage to the biliary system.
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A liver biopsy showed mild portal inflammation, mainly composed of lymphocytes, occasional plasma cells, and eosinophils (Figure 2, Figure 3, Figure 4). The biopsy also revealed ductular reaction and minimal hepatocyte reactive change (Figures 4 and 5).
Hepatic parenchyma away from the portal tracts. Scattered mitoses are seen (1 o'clock and 7 o'clock), suggesting that there has been some damage to the liver, with mitotic activity representing regenerative/reparative changes as the liver heals. The findings in this biopsy are mild but would be consistent with either drug effects or biliary tract disease.
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The biopsy also revealed ductular reaction and minimal hepatocyte reactive change (Figures 4 and 5).
The patient presented with a palmar rash.
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At the subsequent primary care visit, the patient's doctor noted a new palmar rash (Figure 6).