Diabetic nephropathy, which is defined as elevated urine albumin excretion or reduced glomerular filtration rate or both, is a serious complication that occurs in 20–40% of all diabetic patients. In this review, we try to highlight the prevalence of diabetic nephropathy, which is not an uncommon complication of diabetes all over the world. The prevalence of diabetes worldwide has extended epidemic magnitudes and is expected to affect more than 350 million people by the year 2035. There is marked racial/ethnic difference besides international difference in the epidemiology of diabetic nephropathy, which could be attributed to the differences in economic viability and governmental infrastructures. Approximately one-third of diabetic patients showed microalbuminuria after 15 years of disease duration and less than half develop real nephropathy. Diabetic nephropathy is more frequent in African-Americans, Asian-Americans, and Native Americans. Progressive kidney disease is more frequent in Caucasian patients with type 1 than in those with type 2 diabetes mellitus (DM), although its overall prevalence in the diabetic population is higher in patients with type 2 DM because this type of DM is more prevalent. Hyperglycemia is a well-known risk factor for diabetic kidney disease, in addition to other risk factors such as male sex, obesity, hypertension, chronic inflammation, resistance to insulin, hypovitaminosis D, dyslipidemia, and some genetic loci and polymorphisms in specific genes. Diabetic nephropathy is not an uncommon complication of diabetes (type 1 and 2) all over the world and in geriatric population. Management of its modifiable risk factors might help in reducing its incidence in the nearby future.

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Introduction Acute kidney injury (AKI) is a common complication of sepsis in ICU patients. No test has been shown to definitively predict its occurrence and progression to more severe stages. The aim of the study was to investigate the ability of furosemide stress test (FST) to predict the development and progression of AKI in critically ill patients, and to compare it to the level of serum cystatin C. Patients and methods We studied 60 patients who were subdivided into four groups: each group included 15 patients who had normal renal functions, AKI stages 1, 2, and 3, respectively. Clinical, laboratory, and therapeutic data were collected. Serum cystatin C levels were assessed by the enzyme-linked immunosorbent assay technique and FST (at a dose of 1.0 or 1.5 mg/kg according to previous furosemide exposure) was performed for each patient with assessment of their urine output during the following 2 h. Results In our study, we compared the ability of FST to predict the progression of AKI in each stage. The sensitivity of FST to predict the outcome of AKI was 89.29% and its specificity was 93.75%, while the sensitivity of serum cystatin C to predict the outcome was 82.14% and its specificity was 31.25% with area under the curve=0.742. Conclusions The FST in patients with early AKI serves as a cheap, easily available tool to assess tubular kidney function with prognostic capacity to assess the occurrence and the progression of AKI in septic ICU patients.

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Objectives Cystatin C is an alternative parameter for the assessment of renal function. The objective of the study is to evaluate the efficacy of serum cystatin C as a marker of renal dysfunction among different chronic kidney disease (CKD) and postrenal transplant patients. Patients and methods A total of 60 postrenal transplants patients and 60 patients with CKD were compared with 30-old aged patients regarding serum cystatin and through evaluating cystatin-based estimated glomerular filtration rate (eGFR) and creatinine-based eGFR equations versus measured GFR using ^99mTc diethylene-triamine-penta-acetate method. Results Serum cystatin is significantly higher in the CKD group. Cystatin is negatively correlated with measured GFR in all groups, with P value less than 0.01, serum cystatin is a better parameter than serum creatinine to rule out renal dysfunction (sensitivity 95.1 and 80.3%, respectively). Cystatin eGFR (Larsson equation) has less sensitivity and specificity than creatinine eGFR formulae namely modified diet in renal disease and Gault–Cockcroft. Conclusion Serum cystatin C is a useful parameter in recognizing individuals with early renal impairment and can be used as a screening tool with significant performance

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Mesenchymal stem cells (MSCs) are a group of multipotent cells found in cord blood, adipose tissue, bone marrow, and the stroma of various organs with a great potential for mesoderm-like cell differentiation. The aim of the present work was to study the paracrine effect of MSC transfusion in stage II and III chronic kidney disease, which is measured through the level of insulin growth factor-1 and vascular endothelial growth factor. Human bone marrow MSCs were isolated, expanded, and harvested after an average of 21-30 days not only morphologically, when the cells presented as a uniform spindle fibroblast and reached 70-80% confluence with a good cellular yield, but also through their immunophenotypic analysis, which showed positivity for CD29 and negativity for CD34. They were reinjected intravenously in 10 renal patients. To study the effect of such manipulation on the kidney, creatinine and creatinine clearance were measured at the day of injection (baseline), and the first and third month following injection. In addition, other modulators were measured during the first week of injection (day 0, 2, and 7) using enzyme-linked immunosorbent assay. To illustrate, for the first 3 months the creatinine and creatinine clearance reflected a significant renal improvement with an overall decrease of 14% and an increase of 23%, respectively. Although the third month's results may appear worse off than the first month's, they still were better than the baseline before transfusion. Therefore, such an improvement may be attributed to the growth factors released by the MSCs. In other words, both the vascular endothelial growth factor and insulin growth factor-1 showed an overall rise of 3 and 53%, respectively, in their level during the first week after transfusion. Therefore, MSCs transfused to the patients lead to the rise in such modulators, which in turn caused a significant improvement in renal functions. In conclusion, these findings may provide a novel therapy of regenerative medicine especially for chronic kidney disease where dialysis and renal transplantation are inevitable.

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Urological complications can cause significant morbidity after kidney transplant but can be prevented by following well-known good surgical principles and techniques. The key is early identification and appropriate intervention. This article discusses clinical presentation, investigations, and principles of management of a urine leak after kidney transplant on the background of a clinical case. The presence of a ureteric catheter, double J ureteric anastomotic stent, vascularity of transplanted ureter, and bladder capacity is critical for differential diagnosis, choice of investigation, and management of ureteral leak. The given case demonstrates an early extraperitoneal high-volume urinary leak. Additional information about the surgery, graft quality, and postoperative clinical course may help in differential diagnosis. Drain fluid creatinine and potassium analysis compared with serum can confirm the leak, whereas radiological imaging can localize it. Depending on the cause and site of leak identified, a conservative management approach using maximal decompression or surgical repair or reconstruction may be appropriate.

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The aim of this study was to know and validate whether the use of ventriculoperitoneal shunt (VPS) and peritoneal dialysis catheter (PDC) is a safe and acceptable option in children requiring PD and VPS. A case of myelomeningocele with accompanied paraplegia and hydrocephalus was treated surgically in the neonatal period with placement of VPS. Later the child developed a neurogenic bladder with recurrent cystitis, which culminated into severe bilateral ureterohydronephrosis and progressive chronic renal disease. In a second case, a boy with an immaculate past history, admitted in a local hospital for meningitis complicated by hydrocephalus, necessitating the insertion of VPS, was treated. During the course of his illness, the child developed acute renal failure, volume overload, and severe hypertension and ended up in our pediatric ICU. We experienced two cases in our artificial kidney unit with concomitant insertion of VPS and PDC with an excellent outcome. On the basis of the outcomes of our patients as well as results from other centers, we conclude that the concurrent use of a VPS and PDC is a safe and acceptable option in child requiring PD and VPS.

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Background Chronic kidney disease (CKD) is an important risk factor for cardiovascular diseases and mortality. Physical inactivity is a modifiable risk factor that may affect the development and course of CKD. It is well established that exercise improves a number of metabolic factors, as well as blood pressure and insulin resistance, which would be expected to preserve renal function and lower cardiovascular risks. Aim of the study The aim of this study was to investigate the effect of treadmill walking exercise (moderate aerobic exercise) on kidney function tests and lipid profile in patients with CKD stages 3 and 4. Patients and methods Fifty patients with CKD stages 3 and 4 participated in the study. They were selected from the outpatient clinic of Nephrology Department, Zagazig University Hospitals (during the period from January 2015 to June 2015). Their ages ranged from 45 to 55 years. They were divided into two groups: the study group (group B), which included 30 patients who received moderate aerobic exercises on treadmill three times per week for 3 months plus their medications, and the control group (group A), which comprised 20 patients who received their medications only with no training exercises. Urine and blood samples were collected for determining glomerular filtration rate (GFR), serum blood urea, serum creatinine, and serum lipid profile before the initiation of the training program and after the completion of the study (after 3 months). Results There was a statistically highly significant decrease in creatinine, blood urea, triglyceride (TG), cholesterol, and low-density lipoprotein (LDL), and an increase in GFR and high-density lipoprotein (HDL) (P<0.001) in group B after treatment compared with the pretreatment values with the following percent of improvement: creatinine −11.5%, blood urea −7.9%, TG −10.5%, cholesterol −13.1%, LDL −11.9%, GFR +17.4%, and HDL +12.6%. However, there were no significant differences between pretreatment and post-treatment values of creatinine, blood urea, or GFR in group A. There was a significant decrease in TG, cholesterol, and LDL, and a significant increase in HDL in group A after 3 months, with the following percent of improvement: TG −2.9%, cholesterol −3.4%, LDL −5.6%, and HDL +6.7%. There was a statistically significant difference in the post-treatment values of all parameters between the two groups. Conclusion It can be concluded that moderate aerobic exercises improve kidney function tests and lipid profile and can delay progression of CKD stages 3 and 4.

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Diabetes is now the major cause of end-stage kidney failure, both in developing and developed nations. It is the primary diagnosis causing kidney diseases in 20-40% of patients starting treatment for end-stage renal diseases worldwide. The aim of the study was to evaluate the urinary level of vitamin D-binding protein (UVDBP) as a new biomarker for diabetic nephropathy (DN). Urine samples were obtained from 45 patients with type 2 diabetes mellitus and were classified into three groups (normoalbuminuric, microalbuminuric, and macroalbuminuric). Fifteen healthy participants served as the control group. The excretion levels of UVDBP were quantified with enzyme-linked immunosorbent assay. The results showed that UVDBP levels were significantly elevated in patients of the DN3 and DN4 groups compared with those of the DN2 group and normal controls. In conclusion, the current study demonstrated that UVDBP levels were significantly elevated in patients with DN. Moreover, a strong positive correlation was observed between the expression level of UVDBP and the development of DN. Thus, the findings indicate that UVDBP levels are a potential biomarker for the early detection of DN.

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Introduction Muslims fast during the whole lunar month of Ramadan from dawn to sunset. Some studies have evaluated the effect of the different patterns of intermittent fasting including Ramadan fasting (RF) on the perception of fatigue, mood, and cognitive functions in healthy individuals and in some patient groups, but the effect of RF on the perception of fatigue, mood, and cognitive functions was not assessed previously in patients with chronic kidney disease (CKD). Aim This study aimed to evaluate the effect of RF on fatigue, depressed mood, anxiety, and cognition in a cohort of old Egyptian CKD patients who fulfilled fasting during the whole month of Ramadan. Patients and methods This was an observational pilot study that included 20 CKD patients (eight men and 12 women), mean age 61.9 years, who fasted during the whole lunar month of Ramadan. Fatigue, mood, and cognition were assessed using standardized questionnaires before and after RF. Complete blood count, serum creatinine, estimated glomerular filtration rate, serum albumin, body weight, BMI, and body composition assessed by bioimpedance analysis were determined within a week before and within a week after RF. Results RF was associated with significant worsening of fatigue (P=0.001), depressed mood (P<0.000), and cognition (P<0.000), whereas anxiety was not significantly changed (P=0.163). RF was not associated with a significant change in creatinine (P=0.132), estimated glomerular filtration rate (P=0.097), or albumin (P=0.352). RF was not associated with a significant change in body weight (P=0.445) BMI (P=0.168), body fat (P=0.979), muscle mass (P=0.662), or body water (P=0.815). Conclusion RF is associated with significant worsening of fatigue, mood, and cognition in old CKD patients. RF had no significant effect on renal function tests or body composition in these patients.

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Introduction End-stage kidney disease (ESKD) has a major health impact worldwide. Hemodialysis (HD) is the basic renal replacement therapy in our country. In Egypt, like other developing countries, there is no electronic data system that permits simple measurable examination and assurance of the span of the issue for future plans. Aim The aim of this study was to assess the prevalence of ESKD patients on HD in Menoufia governorate, Egypt, as well as the clinical characteristics of such patients to make a core for national data registry. Patients and methods A questionnaire was conducted on ESKD patients on regular HD focusing on demographic data and clinical characteristics of the dialysis population, including smoking history, causes of ESKD, virology status, vascular access, blood transfusion, hemoglobin level, calcium, phosphorus, and parathyroid hormone. Results The prevalence rate of ESKD in Menoufia governorate was 483 patients per million populations. The mean age was 53.18±13.26 years [the highest proportion of patients (36.6%) was aged between 50 and 60 years]; there were 61.6% male and 38.4% female patients. The mean duration of dialysis was 3.78±3.372 years. The main causes of ESKD were hypertension (33.4%) and diabetic nephropathy (9.2%), and the unknown etiology accounted for 32.9% of all causes of ESKD. The prevalence of hepatitis C and B was found to be 42 and 2%, respectively, whereas the prevalence of hepatitis C virus (seroconversion was 7.9%). Conclusion In Menoufia governorate, the prevalence of ESKD patients on regular HD is steadily increasing than that previously reported, especially among older patients. Hypertension and diabetes mellitus are the most commonly accounted causes of ESKD, whereas undetermined etiology accounted for 32.9%. Hepatitis C infection and seroconversion among dialysis patients have been reduced.

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Nonnutritional and nutritional supplements are widely used by bodybuilders. Abuse of these supplements can cause kidney injury by different mechanisms. We refer to any kidney injury caused by any of these supplements as ‘gym nephropathy.’ Anabolic-androgenic steroids are taken by athletes to gain muscle, but they may induce kidney injury through multiple pathways. Creatine supplementation is safe to be used, and it is capable of increasing muscle strength and mass; however, the indiscriminate use of it may induce acute kidney injury. Many bodybuilders abuse oral and injectable vitamins, which may cause acute kidney injury. High protein improves the training adaptations to exercise with no harm as long as the renal functions are normal; however, the theoretical risks should be reviewed carefully with some individuals. Energy drink-induced renal failure has been also reported. In this article, we review different forms of kidney injury secondary to supplements abused by bodybuilders.

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Introduction The Arab world contains 22 countries with a total population of 362.5 million people. The prevalence of diabetes around the world has reached epidemic proportions. It already affects nearly more than 350 million people and is predictable to grow to more than 550 million people by 2035. The prevalence of diabetic kidney disease (DKD) in Arab countries is not well studied. The aim of the study was to review and present the prevalence of DKD among the Arabian population. Materials and methods We reviewed most of the published data − since the 1980s − in different Arabic countries regarding the prevalence of diabetes and DKD. Results The Arab countries with the highest prevalence of T2DM are: the Kingdom of Saudi Arabia (31.6%), Oman (29%), Kuwait (25.4%), Bahrain (25.0%), and the United Arab Emirates (25.0%). The lowest prevalence was found in Mauritania (4.7%) and Somalia (3.9%). Arab countries with high prevalence of micro-albuminuria included UAE, KSA, Bahrain, and Lebanon while KSA, Kuwait, Bahrain, and Egypt represented countries with the highest prevalence of macro-albuminuria. Low prevalence of DM and DKD was found in Iraq and Tunisia. These differences could be attributed to the genetic predisposition and the change in lifestyle. The cumulative incidence of PTDM at 12 months post-transplant was 17.6% in Sudan, 27% in KSA, 27% among the Egyptian liver transplants, 22.2% among the Egyptian kidney recipients, and 33% in Bahrain. There is no data available regarding diabetic kidney disease in renal transplant recipients in Arab countries. Conclusion Diabetic nephropathy is not an uncommon complication of diabetes (types 1 and 2) in Arab countries. Rapid economic growth in some Arabic speaking countries improved the infrastructure, but carries with it the burden of risk factors of DM. Large prospective collaborative studies are critically needed to explore this medical and socioeconomic problem among the Arab people before and after renal transplantation.

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Background Acute kidney injury (AKI) is a frequent complication of Lassa fever (LF) that is notably associated with poor outcome. The study aimed at evaluating the relationship between the clinical parameters and outcome of hemodialysis-treated patients with AKI complicating LF and to highlight our experience between 2014 and 2018. Materials and methods This was a descriptive, observational, and retrospective study involving patients with LF complicated by AKI who had hemodialysis at the dedicated dialysis suite located in our hospital between January 2014 and September 2018. Information were extracted from the clinical and laboratory records of the patients during the period under review. Results A total of 83 patients had 199 sessions of hemodialysis. Male to female ratio was 2.5 : 1. The mean age was 34.3±13.7 years. The mean number of hemodialysis sessions per patient was 2.4±1.5. The frequency of intradialytic complication was 9.6%, whereas hypotension (62.5%) was the commonest. Occurrence of intradialytic complications was significantly associated with mortality (χ²=5.370, d.f.=1, P=0.020). A high incidence of anemia (65.1%) was observed among the patients. Sixteen (19.3%) of the patients died. There was no significant association between age, sex, number of dialysis session or anemia and outcome of LF. Compared with those who died, patients who recovered had significantly higher mean postdialysis diastolic blood pressure (t=2.382, P=0.020). Conclusion Intradialytic complication is infrequent in dialysis treated LF patients with AKI, but has significant association with mortality.

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Background Kidney transplantation is the preferred treatment for chronic kidney disease, but its effect on disordered mineral metabolism is incompletely understood. Post-transplant mineral bone disease (MBD) is an important complication, although its etiology and course vary. Fibroblast growth factor (FGF23) controls phosphate and vitamin D metabolism, and its assessment increases our understanding the pathogenesis of post-transplant bone disease. Aim To determine the regulation of serum FGF23 in relation to other biochemical parameters in our post-transplant participants with preserved renal function. Materials and methods A case–control study conducted on 48 kidney transplant recipients, with age ≥ 18 years old and an estimated glomerular filtration rate (eGFR) > 60 ml/min/1.73m², from the different transplantation centers during their follow-up from 2015 to 2016. They classified in equal number according to their post-transplant follow-up period into: group A; early 6 months, and group B; late 6 months. In addition, 20 healthy persons were enrolled in the study as controls. Patients with graft rejection at the time of enrollment, those with infections and neoplasms or taking medications were excluded. Participants subjected to full history taking and clinical examination. Peripheral hemogram, blood glucose, lipid profile, liver function, kidney function, urine analysis, calcium, phosphorus, parathyroid hormone (PTH), 25-hydroxyvitamin D, FGF23, and 24-h urinary phosphorus were done. Results Significantly high levels of FGF23, PTH, and urinary phosphorous (108.6±92.7 pg/ml, 150.7±51 pg/ ml, and 1170.5±331.1 mg/day with P<0.001 for each) with significant low levels of serum phosphorus and vitamin D3 (2.5±0.9 mg/dl and 21.1±11.4 ng/ml with P<0.001 for each) in early 6-month post-transplant period were found in our patients. However, Nearly equal non-significant levels of corrected serum calcium were found throughout the study. Multivariate linear regression analysis showed significant associations of FGF23 with eGFR and other mineral bone indices in patients groups, with P˂0.05. Receiver operating characteristic curve showed that PTH of high sensitivity and specificity (95.83 and 83.33%, respectively) and phosphaturia of high sensitivity but low specificity (91.67 and 58.33%, respectively) not FGF23 (had low sensitivity and specificity (54.17 and 33.33%, respectively) could be considered as independent markers to regulate MBD in the early post-transplant period. Conclusion FGF23 may play a role in the pathogenesis of MBD in post-transplanted patients. Although, significant associations of FGF23 with other conventional bone mineral indices in early 6-month post-transplant period were confirmed, it could not be considered as an independent marker to regulate MBD in the early post-transplant period. Future prospective studies with larger numbers of transplant recipients are required to establish its direct relationship with development or severity of MBD.

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Background Microvascular vasodegeneration is the major factor in progression of diabetic complications. Adipocytokines secrete a variety of hormones and cytokines, which contribute to the development of vascular and renal diseases. Elevated levels of leptin are observed in chronic renal failure and hypertension. Adrenomedulin (AM), with its antiproliferative effects, is considered as an associated factor in the course of vascular and diabetic insults. However, there is lack of knowledge about the precise role, regulation, production and release at the systemic level of AM, and its correlation with the peripheral blood flow in diabetic vascular insult. Aim We aimed to assess the levels of AM and leptin in type 2 diabetes mellitus (T2DM) patients, to assess their correlations with glycemic control and microvascular complications, and to assess whether these levels vary with the stage of diabetic nephropathy (DN). Patients and methods This is a prospective study including 100 T2DM patients, aged 32–48 years old. Patients were classified into two groups according to albuminuria (group A) and according to estimated glomerular filtration rate (group B). Participants were subjected to history taking, and clinical and fundus examinations. Peripheral hemogram, liver and kidney function tests, lipogram, glycosylated hemoglobin, urine albumin/creatinine ratio, serum leptin and AM were performed. They also underwent ECG and transthoracic echocardiogram. Results The levels of leptin and AM were significantly higher in T2DM patients with microvascular complications than in those without (P<0.001 for each). Leptin and AM levels were progressively elevated in all stages of DN, and the increment was dependent on the severity of DN (P<0.001, for each). There was a significant correlation between AM levels and glycosylated hemoglobin among diabetic patients with microvascular complications. Multivariate logistic regression analysis showed that the odds ratio for the presence of DN in the highest leptin was 4.1 (95% confidence interval: 3.88–5.03, P=0.001); therefore, leptin was an independent risk factor for DN. Conclusion AM and leptin play a role in the pathogenesis of microvasculopathy in T2DM patients. An increased AM and leptin level correlates with poor metabolic control.

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Context Fibroblast growth factor-23 (FGF-23) is secreted by osteoblasts and regulates phosphate and vitamin D homeostasis. As a potential explanatory mechanism of FGF-23-associated mortality, multiple studies have consistently demonstrated that higher FGF-23 levels are independently associated with greater risk of prevalent and incident left ventricular hypertrophy (LVH). In contrast, observational studies reported conflicting results on the association of FGF-23 with arterial calcification, which is another prominent pattern of cardiovascular injury in chronic kidney disease (CKD). Aims The aim was to correlate between serum FGF-23 and vascular calcification (VC) in CKD and hemodialysis (HD) patients. Settings and design A single-center cross-sectional study was conducted on 60 patients who were divided into two groups. Group I included thirty patients with CKD stages 4 and 5, and group II included thirty patients on maintenance HD. Group III included 30 age-matched and sex-matched healthy volunteers. Materials and methods Estimation of serum calcium, phosphorus, bone-specific alkaline phosphatase, intact parathyroid hormone, and serum FGF-23 level was carried out. Assessment of LVH by echocardiography and VC by multidetector computed tomography was done. Results There was a statistically significant negative correlation between FGF-23 and serum calcium level in group I and of no statistical significant correlation in group II and III, whereas there were a statistically significant positive correlations between FGF-23 with serum phosphorus, bone-specific alkaline phosphatase and intact parathyroid hormone in groups I and II and of no statistical significant correlations in group III. There were statistically significant positive correlations between FGF-23 and both left ventricular mass index and VC in groups I and II (P<0.001) and of no statistical significant correlation in group III. Conclusion FGF-23 correlates with LVH and VC in CKD and HD patients.

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Aim Phospholipase A2 receptor (PLA2R) in the past few years has been identified as an antigenic target in idiopathic membranous nephropathy (IMN). The question remains, however, whether the diagnostic and prognostic values of anti-phospholipase A2 receptor (APLA2R) antibodies apply to patients with IMN who are of different ethnicities. The aim of this research was to assess the prevalence of APLA2R antibodies in Egyptian patients with IMN and to describe the clinical importance of measuring APLA2R antibodies in those patients. Patients and methods Using an indirect immunofluorescence (IF) assay, we measured APLA2R antibodies level in 30 patients with IMN in Egypt (three samples/patient). Patients were divided in two groups: group 1 included 15 consecutive patients at the time of diagnosis and group 2 included 15 consecutive patients during their remission or relapse period. Results APLA2R antibodies were detected in 40% of the patients in both groups equally. Overall, 68% of them had a nephrotic-range proteinuria (P=0.002). The titer ranged from 1 : 10 to 1 : 40. The reactive patients had significantly lower serum albumin levels at the presentation (P=0.049), and the average time to remission for them was longer in comparison with the nonreactive patients. Conclusion In our study, APLA2R antibodies were found in 40% of the patients. It correlates with the disease activity regarding remission and relapse, and its reactivity was higher in more severe disease.

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Background Chronic renal failure (CRF) is defined as a slowly progressive loss of kidney functions resulting in permanent kidney failure. Patients with chronic kidney disease (CKD) are at increased risk not only for end-stage kidney disease but also for cardiovascular (CV) disease. CKD is characterized by specific metabolic abnormalities of plasma lipoproteins (LPs). These abnormalities involve all LP classes and show variations depending on the degree of renal impairment, the etiology of the primary disease, the presence of nephrotic syndrome (NS), and the method of dialysis for patients undergoing renal replacement therapy. High LP-a indicates a coagulant risk for plaque thrombosis. Thus, it predicts risk for early atherosclerosis independently of other cardiac risk factors, including low-density lipoprotein (LDL), in patients with CKD. Dyslipidemia in CKD is associated with increased thickness and stiffness of the large arteries. Thus, strict control of dyslipidemia would be beneficial in preventing CVD, at least during the early stages of CKD. The kidney has a vital role in magnesium (Mg) homeostasis, and, although renal handling of Mg is highly adaptable, this ability deteriorates when renal function declines significantly. Mg homeostasis in humans primarily depends on the balance between intestinal uptake and renal excretion. Mg may be normal or decreased in dialysis patients, which is probably due to decreased dietary intake combined with impaired intestinal absorption. In patients on chronic hemodialysis (HD), the major determinant of Mg balance is concentration of Mg in the dialysate. Thus, in patients with CKD, there may be reduced intake, impaired absorption from the intestine, use of diuretics, and acidosis, which may result in decreased serum Mg, whereas reduced renal excretion may cause accumulation of Mg, resulting in increased serum Mg levels in CRF patients. This prospective study aimed to determine the correlation of serum Mg with dyslipidemia in patients on maintenance HD. Patients and methods This case–control observational prospective study was conducted on 37 end-stage renal failure patients on maintenance HD (age range: 20–70 years; mean age: 47.8±13.9 years; 16 men and 21 women) who were recruited from the Renal and Dialysis Unit, Department of Internal Medicine, Assuit University Hospitals, Egypt, from 2010 to 2012. In addition, 25 apparently healthy persons (age range: 17–70 years; mean age: 42.0±13.25 years; 13 male and 12 female) recruited mainly from among the medical staff and their families who underwent a health examination at Assuit University Hospitals were enrolled in the study as a control group. The study was approved by the ethical committee of the Faculty of Medicine, Assuit University, and written informed consent was obtained from each participant. The underlying causes of CRF were chronic glomerulonephritis, diabetes mellitus, chronic pyelonephritis, obstructive uropathy, analgesic and idiopathic nephropathy, polycystic kidney disease, and lupus nephritis. The duration of HD ranged from 5 to 15 years, with a mean duration of 7.0±2.9 years. The frequency of HD was three sessions per week. The type of dialyzer membrane was polysulfone with bicarbonate dialysate and the dialysate flow rate was 500 ml/min. Blood flow ranged from 250 to 300 ml/min. The Mg concentration in the dialysate fluid was 1 mEq/l. Dialysis adequacy was assessed by measuring urea kinetic modeling (mean urea kinetic modeling: 2.38±0.44). Glomerular filtration rate was estimated by the modified MDRD equation. Patients were excluded if they had been taking diuretics and/or lipid-lowering agents or had acute or chronic infections. All participants were subjected to thorough history taking, full clinical examination, and anthropometric measurements including weight, height, and BMI. Blood samples from both patients and controls were drawn in the morning after an overnight fast of 12–16 h. Peripheral hemogram, liver function, kidney function, lipid profile, LP-a, and serum electrolytes such as Ca, phosphorus (P), and Mg were assessed. An ECG was obtained with measurement of the corrected QT interval (QTc). Transthoracic echocardiography (ECHO) was performed in all studied groups on an interdialytic day in the evaluation phase. M-mode and two-dimensional images as well as spectral pulsed and color flow Doppler recordings were obtained. Results Significant renal dysfunction and lower levels of hemoglobin and platelets with higher mean corpuscular volume (MCV) and mean cell hemoglobin concentration (MCHC) with no statistical difference in the mean level of white blood cells (WBCs) were reported in our studied patients in comparison with controls. Notably, highly statistically significantly lower levels of high-density lipoprotein-cholestrol (HDL-C) with significantly lower levels of LDL-cholesterol (LDL-C) were seen in our HD patients. However, the mean levels of triglycerides (TG) and LP-a were statistically significantly higher, with no statistically significant differences in total cholesterol (TC) levels in the studied patients. The levels of P and Mg were highly statistically significantly higher, with lower Ca levels of no statistical difference, in HD patients. There were no statistically significant differences in the main levels of serum Mg among the studied patients. Lipid metabolism disturbances are frequently present in patients with CRF, representing an important factor in premature atherosclerosis development. The majority of patients with no ST-segment changes had more Mg retention and LP-a retention but with no statistical significance. Nonetheless, none of our patients had prolonged QTc interval in ECG, despite having more Mg retention and LP-a retention with no statistical significance. Left ventricular hypertrophy (LVH) was a striking finding in our patients who had more serum Mg retention and LP-a retention but with no statistical significance. A significant positive correlation between serum Mg level and ST-segment changes in ECG and a significant negative correlation between serum LP-a level and ST-segment changes in ECG were found in our studied patients. Moreover, there were positive correlations of serum Mg levels and LP-a levels with LVH in ECG and ECHO findings in our patients, with no statistical significance. The prolonged QTc interval in ECG had a significant positive correlation with the LP-a levels and a nonsignificant positive correlation with serum Mg level. A significant positive correlation of age with TC, TG, and HDL and a nonsignificant negative correlation with LDL were found in our studied patients. However, there were significant negative correlations of the duration of CKD with TC, TG, and LDL and a negative correlation with HDL in our studied patients, with no statistical significance. Nonsignificant negative correlations of BMI with LDL and HDL and significant negative correlations with TC and TG were found in our studied patients. Notably, there was a negative correlation of lipid profile with serum creatinine and blood urea. Nonsignificant negative correlations of serum calcium (Ca) and serum P with LDL were observed, whereas there were nonsignificant positive correlations of serum Ca with TC and TG and negative correlations of serum P with TC and TG, with no statistical significance. The HDL had a significant positive correlation with serum Ca and a significant negative correlation HDL was found in our studied patients, there was a significant negative correlation between HDL and serum phosphorus, however, serum Ca was positively correlated with HDL but with no statistical significance, but a significant positive correlation between LP-a level and MCHC. There were negative correlations between Mg level and hemoglobin, WBCs, and MCV, with no statistical significance, in our patients and significant negative correlations between Mg level and MCHC and platelets. In the current study, there were nonsignificant positive correlations between LP-a level and blood urea and a nonsignificant negative correlation with serum creatinine. Positive correlations of Mg level with blood urea and serum creatinine were found in the study. Notably, serum Mg was statistically significantly positively correlated with LP-a, TC, TG, and LDL-C; however, there was a highly significant negative correlation between HDL-C and serum Mg. No vascular calcification was found in any of the studied patients. Moreover, LP-a and serum Mg were statistically significantly positively correlated with TC, TG, and LDL-C, with nonsignificant negative correlation with HDL-C. A significant positive correlation of hypertension with LP-a and Mg level was found in our studied patients. Nonsignificant negative correlations of Mg level with the age of patients, height, and BMI were found in our studied patients, but significant positive correlations of LP-a with the age of patients and BMI and a nonsignificant positive correlation with weight were found. Meanwhile, there negative correlations of LP-a and serum Mg level with the duration of CKD and the height of patients. Serum P had a significant positive correlation with Mg level and a significant negative correlation with LP-a level in our study. However, a negative correlation of serum Ca with Mg and LP-a levels, with no statistical significance, was detected. In the multivariate logistic regression analysis of the association between serum Mg level, all laboratory parameters of end-stage renal disease (ESRD), and HD in the studied patients there were three factors associated with HD (Mg level, LDL-C, and LP-a). There was a 45-fold increase in the probability of HD per 1 mg/dl increase in the Mg level and this relation was statistically significant [odds ratio (OR)=45, 95% confidence interval (CI): 15.4–68.1, P<0.01]. Mg level revealed a 14% increase in the prediction level in the study sample compared with controls. There was also a 3% decrease in the probability of HD per 1 mg/dl decrease in the level of serum LDL, and this relation was statistically significant (OR=0.97, 95% CI: 0.95–0.99, P<0.05). LDL had a 5% increase in the predictive level. Moreover, there was 68% increase in the probability of HD per 1 mg/dl increase in the level of LP-a and this relation was statistically significant (OR=1.68, 95% CI: 1.01–2.3, P<0.05). LP-a revealed a 6% excess in the prediction of HD. Conclusion In essence, CKD is characterized by specific metabolic abnormalities of plasma LPs. High serum LP-a and low HDL-C are highly atherogenic and are two factors that accelerate atherosclerosis in patients with CKD and correlate with CV mortality. The kidney has a vital role in Mg homeostasis, and, although the renal handling of Mg is highly adaptable, this ability deteriorates when renal function declines significantly. Mg does not increase the LP synthesis. Patients with CKD on maintenance HD show positive correlations between serum Mg and serum HDL-C, LP-a, and TG levels. Therefore, Mg has a protective role in hypertension, arrhythmia, atherosclerosis, and vascular calcification in ESRD patients. Notably, the low serum Mg may be an independent risk factor for premature death in CKD patients. Although the exact role of Mg in bone metabolism is unclear, it may have both positive and negative effects, and it is uncertain what the optimal Mg levels are in uremic patients. Nonetheless, the dialysate Mg concentration is a major determinant of HD or peritoneal dialysis patients’ Mg balance, but the intradialytic CV and hemodynamic benefits of varying Mg concentration in patients’ dialysate are unclear. Acquired prolonged QT-interval syndrome is a highly prevalent condition in patients with CKD undergoing HD and is one of the known pathophysiological mechanisms of sudden death in this population. The high serum LP-a level and Mg depletion in CKD patients on maintenance HD displayed a high frequency of abnormal electrocardiographic findings, including a high prevalence of patients with prolonged QTc interval. Nephrologists must pay attention to identifying patients with prolongation of the QT interval and the associated clinical and laboratory conditions, such as structural changes of the heart, cardiac calcification, Mg depletion, high serum LP-a level, and the prescription of drugs that induce QT interval prolongation, particularly in patients already presenting an extended QT interval. LVH is a striking ECHO feature among our HD patients. Numerous studies now provide strong suggestive evidence for a protective role of Mg in vascular calcification, arrhythmias, and atherosclerosis in ESRD patients. Our results allow us to speculate on the possible salutary role of increasing plasma levels of Mg to facilitate the healing of vascular injuries and to prevent atherosclerosis, hypertension, arrhythmia, and chronic myocardial ischemia. Mg-based compounds have the additional advantage of being much cheaper to use than some newer alternatives. Nevertheless, in an era of numerous negative studies in nephrology, the long-term effects on either the inhibition of vascular calcifications, reduction of ischemic disease, prevention of arrhythmias, or changes in bone morphology have not been adequately investigated. Moreover, a link between BMI and the presence of Mg retention and high LP-a level was observed. New studies need to be outlined, using accurate nutritional status markers for HD patients, to better observe the possible link between malnourishment and prolonged QTc interval.

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Objective The aim of this study was to study the prevalence of diabetic nephropathy (DN) and the related risk factors among diabetic patients attending El Mahalla General Hospital. Background DN is the leading cause of chronic kidney disease and end-stage renal disease in developing countries. Early detection and risk-reduction measures can prevent DN. In Egypt, the prevalence of DN as a cause of end-stage renal disease increased from 8.9% of patients in 1996 to 14.5% in 2002. Studies in patients who have or do not have clinically evident DN have identified a number of factors to be associated with an increased risk of renal involvement. Participants and methods This study was carried out on 100 diabetic patients who attended El Mahalla. All the participants studied were subjected to a full assessment of history, a general clinical examination, and laboratory investigations including determination of glycated hemoglobin (HbA1c), serum creatinine, estimated glomerular filtration rate, and the urinary albumin to creatinine ratio. Results The results showed that 78% of all the patients studied had DN. There were statistically significant relationships between nephrogenic diabetes and duration of diabetes (P = 0.008), higher systemic blood pressures (P = 0.003), an evident decrease in the glomerular filtration rate through the course of disease (P = 0.038), poor glycemic control (P = 0.036), obesity (P = 0.002), and a family history of diabetes (P = 0.006). There were no statistically significant relationships between nephrogenic diabetes and age, sex of the patient, use of oral contraceptive pills, and smoking. Conclusion Screening for microalbuminuria will enable early identification of patients with DN. Duration of diabetes mellitus and hypertension were strong predictors associated with the development of DN in the patients studied.

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Background Polymorphism has been described in many immunoregulatory molecules that play a role in the rejection process. It has offered a possible explanation for the individual difference in rejection susceptibility and renal graft survival independent of other risk factors. The aim of this work was to study the impact of the interleukin-10 (IL-10) cytokine gene polymorphism on the clinical course and outcome of a renal transplant. Materials and methods This work included 50 transplant recipients treated with a sirolimus-based immunosuppressive regimen for IL-10 cytokine gene polymorphisms. After transplantation, patients were classified into two groups: in group A, patients (12 patients) received sirolimus, tacrolimus, and steroid and in group B, patients (38 patients) received sirolimus, mycophenolate mofetil, and steroid. The results were correlated with rejections (acute and chronic) and patient and graft survival. Results In our study, we found no impact of IL-10 on the incidence and degree of acute rejection episodes, incidence of chronic allograft nephropathy, pathological changes in protocol biopsies, graft function, and graft and patient survivals. Conclusion On the basis of this work, we concluded that there is no impact of IL-10 cytokine gene polymorphisms on the clinical course and outcome of a renal transplant. Genes other than IL-10 could probably be involved as key molecules in graft function.

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Background Diabetic nephropathy (DN) is a serious kidney-related complication of diabetes. It is also called diabetic kidney disease. Up to 40% of people with diabetes eventually develop kidney disease. Several genome-wide association studies have introduced engulfment and cell motility 1 (ELMO1) as a candidate gene that is associated with DN. This study assessed the association of ELMO1 gene polymorphisms with DN to investigate the effects of ELMO1 gene on susceptibility to DN in Kerbala/Iraqi province. Aim The current study aims to identify the role of ELMO1 gene polymorphism, single nucleotide polymorphism (SNP) rs741301, as a candidate gene for susceptibility to DN among patients with type 2 diabetes mellitus and its association with the development and progression of this disease and to verify the relationship between the investigated SNPs of ELMO1 gene with the phenotype changes in particular kidney function tests and other kidney biomarkers that may be seen in patient. Patients and methods A case–control study was conducted for a period of 14 months, starting from January 2018 to March 2019, in Al-Husain Medical City and Al-Kafeel Super Specialty Hospital in Kerbala. A total of 72 participants were divided into two groups: 36 patients with type 2 diabetes with nephropathy and 36 nonnephropathic patients with type 2 diabetes. DNA was extracted from the blood, and then genotyping of the SNP rs741301 was carried out by Tetra ARMS-PCR by using special primers. Results The genotype and allele frequencies were examined under the codominant, dominant, and recessive models with the use of multinomial logistic regression analysis. The patient with DN with the heterozygous genotype GG+AG (odds ratio=5.28, confidence interval=1.35–20.73, P=0.017) were higher than diabetic patients with GG+AG (odds ratio=4.231, confidence interval=1.06–16.97, P=0.042) under with dominant model. Conclusion SNP rs741301 of ELMO1 gene was associated with DN due type 2 diabetes complication in Kerbala/Iraqi province.

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Ramadan fasting is one of the five pillars of Islam and is compulsory for all adult Muslims who have no medical or religious excuses. Ramadan fasting is defined as a complete abstinence from food, drink, medications, sexual activity, and smoking from dawn to dusk. Regarding the kind Islamic religion, patients have permission not to fast according to the medical advice. However, most Muslim patients express their desire to fast during Ramadan month and they are very broken when their physicians inform them not to fast. There are a lot of controversies regarding Ramadan fasting for chronic kidney diseases (CKD) and hemodialysis patients with absence of strict guidelines that help nephrologists in this issue. Renal transplant recipients who have stable kidney function for at least 1 year post-transplantation can fast with cautious follow-up. Risk of dehydration due to fasting for long periods especially in the summer season is the main concern for patients with kidney stone diseases. There is still no strong evidence if that Ramadan fasting can induce renal stone formation in susceptible patients or not. However, most studies have shown that fasting for this kind of patients with good hydration after breaking the fast may be allowed without significant risk of renal colic incidence. According to the last published guidelines by the International Diabetes Federation and Diabetes and Ramadan International Alliance, Chronic dialysis or CKD stages 4 and 5 and CKD stage 3 patients are considered to be at very high risk and high risk categories, respectively, and are exempted from fasting.

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Native nephrectomy (NN) is not routinely performed in the context of kidney transplantation. Certain clinical circumstances necessitate performing NN such as large polycystic kidneys impairing patient’s quality of life and hindering graft implantation. NN may be done either before, simultaneously with, or after kidney transplantation. Although several studies have reported the potential benefits of the pretransplantation approach, others defended the simultaneous approach postulating that it is feasible and satisfactory. Nevertheless, still the ideal timing of NN is not settled, and several factors determine the choice of nephrectomy timing, including the presence of pressure symptoms, residual diuresis, and adequate space for the graft and living (not deceased) kidney donation. Answering these questions will help in decision making to attain an individualized approach that would help in achieving optimum timing of NN in relation to kidney transplantation.

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