Persistent hypertransaminasemia in asymptomatic children: A stepwise approach

Table 1 Main causes of asymptomatic hypertransaminasemia in children

Hepatic origin	Extrahepatic origin
Obesity (non-alcoholic fatty liver disease)	Duchenne/Becker muscular dystrophy (prevalence: 1:4700)
Viral infections (major and minor hepatotropic viruses)	Other myopathies (e.g., caveolinopathies; prevalence: 1:14000 to 1:120000)
Autoimmune liver disease	Myocardiopathies
(prevalence: 1:200000)
Celiac disease and inflammatory bowel disease	Nephropathies
Wilson’s disease (prevalence: 1:30000)	Hemolytic disorders
Cystic fibrosis (prevalence: 1:2500) and Shwachman-Diamond syndrome (prevalence: 1:50000)	Macro - AST (prevalence: 30% of children with isolated aspartate aminotransferasemia)
Alpha1 antitrypsin deficiency (prevalence: 1:7000)
Other genetic and metabolic diseases1
Toxic: Drugs and alcohol
Cryptogenic hypertransaminasemia

¹Refer to Table 3. AST: Aspartate aminotransferase.