Background Variable prophylaxis regimens have been adapted to guard against cytomegalovirus (CMV) after renal transplantation. High-dose valganciclovir (VGCV) is the gold standard, but it is of very high cost. Herein, we compared another low-cost regimen [low-dose valacyclovir (VCV)] with low-dose VGCV to assess the efficacy and safety of VCV. Patients and methods This is a single-center randomized controlled trial that was held in Urology and Nephrology Center, Mansoura University, Egypt. The patients were divided into two groups according to CMV prophylaxis regimen used. Group I included 40 kidney transplant recipients who received low-dose VCV (2 g b.i.d.), and group II included 40 kidney transplant recipients who received low-dose VGCV (450 q.d.). Results Our patients’ age ranged from 18 to 58 years, and the majority were males. The median years of transplantation were 1.9 years. Efficacy of both regimens was similar. Interruption of VCV was more frequent, with significant difference, and it was associated with increased incidence of CMV infection but without any statistical significance. The cost of low-dose VGCV was very high in comparison with low-dose VCV. Conclusion Low-dose VCV showed the same efficacy and safety of low-dose VGCV as CMV prophylaxis protocol after kidney transplantation.

Background Hepatitis C virus (HCV) is considered one of the major causes of chronic liver disease in Egypt. HCC is a common complication of liver cirrhosis; it is the most common malignant neoplasm among Egyptian males and the second one in Egyptian females. The aim of the current study is to investigate the effect of our national DAA treatment protocol on the serum levels of IL-10, and VEGF in HCV infected hemodialysis patients. Patients and methods This study was carried out in Alexandria, Egypt. 85 subjects were enrolled in this study and divided into three groups. The first group was the control group, it included 25 healthy subjects, the second group included 50 hemodialysis patients infected with chronic HCV G4, they received DAAs therapy for 12 weeks, and the third group comprises 10 HCV chronic hemodialysis patients with HCC. Results Sustained viral response (SVR12) had been achieved in 43 patients (86%) in group two. There was a clear increase in the serum level of IL 10, and VEGF in HCV+HD and HCV+HD+HCC from control (P<0.001) Logistic regression analysis showed that serum IL10, and VEGF could be utilized as predictor marker of (HCV+HD and HCV+HD+HCC) group from control and for HCV+HD from control ROC analysis detected 90% sensitivity and 92 % specificity to discriminate between healthy subjects and HCV+HD+HCC group. Conclusion Study demonstrated that high levels of IL-10 and VEGF in both HCV+HD and HCV+HD+HCC (higher levels) patients. Attainment of SVR12 with combination of ombitasvir paritaprevir, and ritonavir plus ribavirin in HCV+HD is potential without major side effects, and it was achieved regardless the serum levels of IL-10 or VEGF.

Background Cardiovascular disease (CVD) is the main cause of death in patients with systemic lupus erythematosus (SLE) and lupus nephritis (LN). This study aimed to evaluate the prevalence of myocardial injury among patients with SLE without nephritis and patients with LN, determine whether serum high-sensitivity cardiac troponin T and creatine phosphokinase-MB (CKMB) might help to identify patients with LN at risk for CVD, and identify LN as a risk factor for myocardial injury. Patients and methods This study was conducted on 50 patients (30 patients with LN and 20 patients with SLE without nephritis). The SLE disease activity index (SLEDAI) and Systemic Lupus International Collaborating Clinics Damage Index (SLICC/DI) were assessed. Laboratory investigations, cardiac enzymes (Hs-TnT and CKMB), and transthoracic echocardiography were performed. Results The results demonstrated a higher prevalence of CVD in patients with LN. A total of 28 patients with LN (93.3%) vs 10 patients with SLE (50%) had detectable high-sensitivity troponin (Hs-TnT) levels, with a mean 29.77±18.22 vs 7.2±6.21 ng/l, respectively. The mean value of CKMB was higher in patients with LN than patients with SLE (23.9±18.6 vs 14.8±9.4 μg/l, respectively). Multilinear regression analysis for Hs-TnT revealed that low estimated glomerular filtration rate, high urinary albumin-to-creatinine ratio, low ejection fraction, and different ECHO diameters were the most statistically significant predictors of troponin elevation, with a P value less than 0.05. The strongest renal predictors of CKMB were estimated glomerular filtration rate and proteinuria, with a P value less than 0.05. Conclusion CVD is more in patients with LN than patients with SLE. Hs-TnT levels is a signature of subclinical cardiac disease, which could be used to identify at-risk individuals. CKMB and echocardiography lack adequate sensitivity for the diagnosis of myocardial injury in patients with LN.

Background Critically ill patients are at risk of developing critical illness-related corticosteroid insufficiency (CIRCI). This may present as hypotension, unresponsiveness to catecholamine infusions, and/or ventilator dependence. Acute kidney injury (AKI) usually complicates critically ill patients and is associated with hemodynamic instability. There is usually failure to predict the severity and to assess the response to therapy in AKI. The aim of this study was to assess the plasma cortisol level and its relation to hospital mortality in AKI patients. Patients and methods This is a prospective, observational study that included 66 patients with AKI admitted to the Dialysis and Nephrology Unit, Mansoura University Hospital, who were assessed clinically, followed by cortisol level assay done at the day of admission. Patients were followed clinically and biochemically till discharge. Patients were classified according to random plasma cortisol level into two groups: group 1 included 14 patients with random plasma cortisol of less than 10 μg/dl (CIRCI group) and group 2 included 52 patients with random plasma cortisol of greater than or equal to 10 μg/dl. Results There was a significant increase in platelet count in group 1 compared with group 2, while there was a significant decrease in serum potassium level in group 1 compared with group 2. Moreover, there was a significant decrease in urine output volume in group 1 compared with group 2 (P=0.03). Finally the hospital mortality rate was significantly higher in group 1 (CIRCI group) compared with group 2 (P=0.004). Conclusion AKI patients with low cortisol level at admission have higher mortality rate during the hospitalization period.

Background It has been demonstrated that acute rejection (AR) episodes are major risk factors of renal allograft loss. Still the impact of early acute rejection (EAR) on long-term graft survival is debated. The aim of this study was to study the impact of early acute rejection (EAR) and late acute rejection (LAR) on renal allograft survival. Patients and methods In this retrospective study we investigated the timing and frequency of AR episodes in 120 kidney transplant recipients for a 3-years period. Patients were divided into three groups; Group I: No acute rejection (No-AR), Group II: Early acute rejection (EAR), and Group III: Late acute rejection (LAR). The graft survivals in the three groups and the associated risk factors were analyzed. Results Of the 120 recipients one patient died (0.08%) and 14 grafts were lost (11.6%). The graft survival durations were 35.2, 23.6 and 27.2 months and the 3-years survival rates were 93%, 63.3% and 66.7% in the three groups respectively. The graft survival durations and rates were significantly higher in group I compared to groups II and III with no significant differences between the last two groups. Conclusion Both EAR and LAR have deleterious effects on graft survival following kidney transplantation.

Background Malnutrition, an important problem in geriatric medicine, is becoming more recognized in hemodialysis patients, as a factor that can even worsen the prognosis and the quality of life of these patients. It is imperative for the nephrology community to recognize this syndrome of malnutrition and work to manage it. Malnutrition can be detected commonly in all age groups of dialysis patients, and it represents a sensitive marker for morbidity and mortality better than chronological age. It could also act as a major cofactor for depression and cognitive impairment development in dialysis patients. We aimed to assess the nutritive status of the elderly patients with end-stage renal disease (ESRD) undergoing hemodialysis using modified subjective global assessment score (M-SGAS) and to correlate between it and different biochemical parameters. Patients and methods A total of 100 ESRD elderly patients on regular hemodialysis were included. All patients were subjected to the following: history taking, including weight change, dietary intake, gastrointestinal symptoms, and functional capacity (nutritionally related functional impairments, comorbidity); physical examination, including decreased fat stores or loss of subcutaneous fat (eyes, triceps, biceps, and chest), signs of muscle wasting (temple, clavicle, ribs, knee, interosseous, quadriceps, and scapula), mid-upper arm and calf circumference, and BMI; malnutrition score (sum of all number) using SGAS; and laboratory investigations, including complete blood count, serum creatinine, blood urea, C-reactive protein, serum albumin, parathyroid hormone, serum calcium, serum phosphorus. urea reduction ratio, and KT/V. Results There was a decrease in anthropometric measures in both males and females, indicating that both sexes are prone to malnutrition to the same degree. On comparing between male and female patients with respect to total M-SGAS, they lie in the moderate degree of total M-SGAS, with no significant difference between males and females. There was a statistically significant negative correlation between M-SGAS and triceps skin fold, mid-arm muscle circumference, and mid-arm circumference, and also there was a statistically significant negative correlation between duration of dialysis and mid-arm circumference. Conclusion The M-SGAS can be used as reliable, rapid, and precise method for nutritional assessment in elderly patients with ESRD on regular hemodialysis. There is a high prevalence of malnutrition among all age groups, even those younger than 40 years old. Malnutrition is associated with female sex, hypoalbuminemia, increased inflammatory markers such as elevated C-reactive protein and elevated total leukocytic count, and in those with low hemoglobin level. Malnutrition also is more detected in patients with hyperparathyroidism.

The unnecessary need for hemodialysis based on abnormal laboratory investigations is rare. We report a case of a 36-year-old male patient who complained of abdominal pain and passing red colored urine, with documentation of azotemia and hyperkalemia. He underwent unnecessary hemodialysis before a diagnosis of factitious disorder could be made.