Background Chronic inflammation as a major determinant of ‘dialysis syndrome’ is considered as the main factor of morbidity and mortality in dialysis patients. Tumor necrosis factor-alpha (TNF-α) may play important roles in the development of T helper (Th) imbalance, cardiovascular disease, and wasting in the uremic milieu. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide that may be an independent risk factor for endothelial dysfunction and cardiovascular disease. In hemodialysis (HD) patients, plasma ADMA is a strong and independent predictor of overall mortality and cardiovascular outcome. The aim of this study to evaluate the acute effects of hemodiafiltration (HDF) compared with conventional HD on blood levels of ADMA and TNF-α. Patients and methods A cross-sectional study was conducted on 20 patients with end-stage renal disease receiving dialysis in the dialysis unit of Ain Shams Specialized Hospital receiving twice weekly HD session with high-flux (HF) dialyzer and once weekly HDF session. Blood samples were collected from all participants before and after HD session and from the same participants before and after HDF session. ADMA and TNF-α levels were assessed by enzyme-linked immunosorbent assay techniques. Results The decrease in TNF-α was higher after HDF session versus HF HD session (79.47 ± 14.16 vs. 50.43 ± 31.05), with P value of 0.001. Moreover, the decrease in ADMA was higher after HDF session versus HF HD session (75.01 ± 12.55 vs. 41.79 ± 24.73), with P value of 0.001. Conclusion The use of online HDF technique showed a significant reduction of ADMA and TNF-α in adults with end-stage renal disease.

Background The outcomes of coronavirus disease 2019 in renal-transplant recipients may differ from the general population because of chronic immunosuppression and comorbidities. The aim of this study is to provide information on the clinical characteristics and outcomes of hospitalized renal allograft transplant recipients with coronavirus disease 2019 is restricted in the Arab region. This study aims to narrow this gap. Patients and methods The study was done on 21 renal allograft transplant recipients admitted in the isolation ward of a single Egyptian center for kidney diseases and transplantation during the period from July 2020 to July 2021, all cases were analyzed regarding their clinical presentation, follow-up, workup done, management, and outcomes. Results The main clinical presentations were fever 90.5% and respiratory symptoms 66.7%, not different from the general population. Their clinical course showed remarkable incidence of acute kidney injury (57.1%) than the general population, but mortality was not (14.3%). Remdesivir was tolerable, no noticeable side effects, and did not affect graft function. Conclusion This category of patients need special care, lowering of immunosuppresion during infection, close monitoring of kidney function, and respiratory status. They can receive ventilator support and same treatment as general population, including Remdesivir and Tocilizumab. Both patient and graft survival can be achieved.

Background Chronic hyperglycemia is a characteristic feature of diabetes mellitus and responsible for its long-term microvascular and macrovascular complications. One of the most problematic issues concerning diabetes complications is diabetic nephropathy ending with renal impairment and costly treatment. Defining new biomarkers to detect renal affection in diabetic patients is necessary. So, we aimed to evaluate serum immunoglobulin G (IgG) as a marker of early renal affection. Patients and methods In this study, 50 patients with type-2 diabetes were selected and classified according to their albuminuria and glomerular filtration rate, 25 apparently healthy participants were enrolled as a control group. We measured serum IgG levels in patients and control groups. Results Significant higher mean levels of serum IgG were observed with diabetic patients more than the control group and higher in patients with normoalbuminuria and microalbuminuria with P value less than 0.001 for each, however, significant lowest mean levels of serum IgG in the patients with macroalbuminuria when compared with other degrees of albuminuria, significantly higher mean levels of serum IgG were observed in stage-IV nephropathy when compared with other stages of chronic kidney disease (P≤0.001). There was a significant positive correlation between serum IgG and blood urea, serum creatinine, glycosylated hemoglobin, and albuminuria and proteinuria, and a significant negative correlation with estimated glomerular filtration rate with a significant difference in microvascular and macrovascular complications between the stages of chronic kidney disease and serum IgG levels. Conclusion Serum IgG is a simple test that can be used as a predictive biomarker for early renal affection in type-2 diabetic patients.

Background Improvements in clinical care and immunosuppressive medications have provided positive outcomes following kidney transplantation such as reducing acute rejection rates. Activation of the complement cascade is inevitable in kidney transplantation because of both the specific and nonspecific immunologic responses of the recipient. This study provides insights on the influence of the donor C3 allotype on renal transplant outcome (graft function). Patients and methods The present study was conducted on 50 pairs of donors and recipients of renal transplantation who fulfilled the inclusion and exclusion criteria. C3 allotypes of donor–recipient pairs were determined and divided into four genotypic groups according to the C3F allotype of the donor and the recipient. The four genotypic groups were analyzed for association with graft function and assessed by serum creatinine, blood urea, and glomerular filtration rate. Results There was a positive statistically significant difference for the group FF/FS donor into SS recipient in comparison with other genotype groups of C3 among recipients, as shown by improvement in glomerular filtration rate, serum creatinine, and blood urea. Conclusion The presence of C3 (F) allele either homozygous or heterozygous in the donor and the absence of this allele in the recipient give a better renal allograft function.

Background Sleep disorders are common among end-stage renal disease patients undergoing hemodialysis (HD). The etiology of sleep disorders in these patients is known to be multifactorial. However, the role of hydration status in sleep disorders in HD patients is not well studied. Therefore, our aim was to study the effect of predialysis fluid overload on sleep quality in HD patients. Patients and methods This cross-sectional study included 100 prevalent HD patients from the HD unit of El Sahel Teaching Hospital. Fluid status and fluid compartments [total body water), extracellular water (ECW),and overhydration (OH) index] were analyzed by a portable whole-body bioimpedance spectroscopy (body composition monitor) before a mid-week dialysis session. OH was defined as OH/ECW% more than or equal to 15%. HD patients were then classified into two groups: group 1 (normohydrated) and group 2 (overhydrated) according to the relative OH index (OH/ECW%). Sleep quality was assessed in all patients by the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Patients with concurrent diagnosis of either obstructive sleep apnea or psychiatric disorder and patients on any medications that affect the sleep pattern were excluded. Results Our study included 100 HD patients (49 male, 51 female; mean age, 49.3 ± 11); 42 (42%) patients had OH (i.e. group 2). Poor sleep quality (defined as PSQI score ≥5) was reported in 57% (n=57) of HD patients included in our study. Poor sleep quality was significantly higher in the HD patients with OH (group 2). Total PSQI scores were significantly higher in overhydrated patients (group 2) compared with normohydrated patients (group 1) (7.92 ± 3.32 vs. 4.83 ± 2.27, P≤0.001). The component scores 1, 2, 3, 4, 6, and 7 of the PSQI showed significant higher values (i.e. poor sleep quality) in overhydrated patients (group 2). Moreover, there was significant positive correlation between total PSQI score both of OH (r=0.259, P=0.009) and OH index (OH/ECW%) (r=0.283, P=0.004) in all HD patients included in the study. Conclusion We may conclude from our study that sleep disorders are prevalent in HD patients. Predialysis fluid overload in HD patients may be associated significantly with poor sleep quality.

Introduction and aim Myositis is a rare complication following renal transplant and is most commonly the result of a drug-mediated myotoxicity, but the idiopathic cause is still the most common. After kidney transplant, the differential diagnosis of polymyositis includes autoimmune disease, drug-induced viral infections, and rhabdomyolysis associated with electrolyte imbalance. We aimed to report a case of idiopathic polymyositis in a renal transplant recipient and review the literature for similar cases. Case report A 31-year-old male patient developed polymyositis three years following live-related kidney transplantation. Electromyography confirmed myopathic changes. The clinical features and course, MRI findings, electromyography features, positive anti-MI-2 antibody, and the response to high-dose steroid therapy are matched with immune-mediated acute polymyositis, especially after excluding viral infections and drug-induced myopathy. Conclusion Acute polymyositis may occur after a kidney transplant. Possible mechanisms include viral antigen transmission or a localized graft versus host disease. Muscle biopsy is not mandatory before prompt initiation of high-dose steroid therapy, which leads to clinical and biochemical recovery.