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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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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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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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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To avoid renal allograft rejection and loss, human leucocyte antigen compatibility and lymphocytotoxic cross-matching of renal donors against prospective renal allograft recipients are obligatory and fundamental steps in pretransplant evaluation. The complement-dependent cytotoxicity assay has been the mainstay technique for ascertaining the presence of donor-specific antibodies since the 1970s. Improvement in the performance of cross-matching has seen the introduction of more sensitive and specific techniques such as flow cytometry, and highly sensitive enzyme-linked immunosorbent assay, Luminex platforms and virtual cross-match. This review article is an in-depth comparison of the advantages and disadvantages of each of the cross-match techniques. We demonstrate the application of these techniques through a clinical case scenario. A step-by-step analysis and interpretation of cross-match modalities of varying levels of sensitivity and specificity is needed to arrive at a pragmatic decision, which will lead to better transplantation outcome. In some patients with immunologically complex issues, a spectrum of cross-match techniques may be required for a safe outcome of transplant.

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The real effect of parasitic infection on transplant recipients is not known. Interestingly, only 5% of human parasitic infections can affect functioning of transplanted organs. Parasitic infections manifest in two different ways: first, systemic illness, including anemia and constitutional symptoms, and second, local syndromes, which are usually confined to the lower gastrointestinal tract. Examples for pathogens causing systemic disease are Plasmodium malaria, Leishmania, Trypanosoma, and Toxoplasma. On the contrary, protozoal infection with Cryptosporidium and microsporidia, or the nematodes such as Strongyloides, may manifest with the local syndromes. Management of these infections in transplant recipients entails the following: prevention, timely diagnosis, cultures, specific serological tests, and PCR testing. Once the diagnosis is established, prompt medical/surgical interventions should be instituted to save these patients from developing hyperinfection or disseminated parasitic syndromes, involving, for example, the lungs or the central nervous system.

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Kidney transplantation is the treatment of choice for patients with end-stage renal failure. Living kidney donation has increased over the past few years and now accounts for 34% of the total kidney transplant programme in the UK. Reasons for the increase in living kidney donation include shortage of deceased donor organs and the possibility to perform pre-emptive kidney transplantation and antibody-incompatible transplantation. In addition, some prefer living kidney donation as this option is associated with better patient and graft survival. However, although kidney donation is considered safe in low-risk individuals, it is important to remember that the donor will have to undergo major surgery and lead a life with a solitary kidney with associated lifelong implications including reduction in renal function. Despite various national guidelines, several studies have shown significant variation in acceptance criteria among centres. This mirrors the controversies as to whether donors with certain characteristics can be accepted for donation. This is particularly important given recent publications regarding the long-term risks associated with donor nephrectomy. In view of this, it is essential that prospective living kidney donors are fully informed of the risks associated with donor nephrectomy. This ensures that the process of living kidney donation is underpinned by informed consent that is freely given to ensure donor autonomy is safeguarded. In this review, we discuss the short-term and long-term risks associated with donor nephrectomy with a view to proposing a protocol to help individualize the assessment of the potential living kidney donor.

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Background Many maintenance hemodialysis (MHD) patients exhibit erythropoietin (EPO) hyporesponsiveness. An inverse association has been found between vitamin D levels and EPO requirements in patients with chronic kidney disease. Vitamin D supplementation may improve response to EPO by either suppression of the chronic inflammatory status, control of hyperparathyroidism, or direct stimulation of erythroid progenitors. Aim A prospective clinical study is needed to assess the potential therapeutic role of vitamin D supplementation on EPO resistance index (ERI) in MHD patients. Methods A total of 30 patients with anemia on MHD for more than 6 months were included. They were on standard anemia therapy with subcutaneous (SC) EPO 4000 U and intravenous iron sucrose 100 mg once or twice weekly. A total of 20 age- and sex-matched healthy individuals were included as controls. Baseline laboratory studies included complete blood picture, calculation of ERI [weekly EPO dose/body weight in kg/hemoglobin (Hb) level], serum iron, total iron-binding capacity, ferritin, hepcidin, calcium, phosphorus, alkaline phosphatase (ALP), intact parathyroid hormone, 25(OH) vitamin D (vitamin D₃), C-reactive protein, and interleukin (IL)-6. The studies were repeated after 3 months of oral α-calcidol therapy (2 µg thrice weekly, with each dialysis session). Results Hb increased significantly from 8.34±0.9 to 9.48±0.9 g/dl (P=0.000), and ERI decreased significantly from 7.39±1.13 to 6.61±1.2 IU/kg/g/dl (P=0.000). Inflammatory markers (serum C-reactive protein, IL-6, ferritin, and hepcidin) decreased significantly (P=0.000 for all). Serum intact parathyroid hormone and ALP decreased significantly (P=0.007 and 0.000, respectively). At the start of the study, there was a significant positive correlation between ERI and serum ferritin (P=0.026), and a significant negative correlation between serum vitamin D3 level and ALP (P=0.004). At the end of the study, there was a significant negative correlation between serum vitamin D3 level and each of serum ferritin (P=0.005) and IL-6 (P=0.019). Conclusion A 3-month course of oral α-calcidol significantly ameliorates hyperparathyroidism and inflammatory markers, increases Hb, and decreases ERI in MHD patients.

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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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Although BK virus (BKV) was discovered in 1971, it took almost three decades for this virus to be routinely considered as a possibility among a plethora of causes of renal dysfunction in a kidney transplant recipient. BKV infection, an early complication of renal transplant, often presents within the first year after transplantation. It presents as an asymptomatic gradual rise in creatinine with tubulointerstitial nephritis that mimics acute rejection and poses a diagnostic and therapeutic dilemma. More frequent diagnosis of BKV infection over the past 2 decades is a consequence of more potent immunosuppression (aimed to prevent acute rejection episodes and, thereby, improving allograft survival). Untreated BKV infections cause renal allograft dysfunction and subsequently allograft loss. A routine screening protocol for early recognition of asymptomatic BKV infection has been reported to result in better allograft outcomes. This review is aimed to discuss the most recent evidence addressing the virology, pathogenesis, clinical features, diagnostic tools, screening protocols, treatment strategy, and short-term and long-term renal allograft survival concerning BKV infection.

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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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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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Corticosteroid use to prevent rejection is ancient but pivotal in transplant immunotherapy. Its benefits are worrisomely being negated by its numerous side effects that affect the quality of life and add to the cost of treatment among transplant patients. The past three decades has witnessed an important dynamism with the advent of many other immunosuppressive agents in various combination protocols, which has led to reports of reduction in episodes of acute rejection. This, in addition to side effects, has raised the question of the need for chronic use of steroid or its avoidance from outset. The benefits of steroid-sparing are compelling especially in low-risk recipients and, recently, paediatric patients. The burden of cardiovascular diseases, the major cause of death in transplant patients, osteopenia and impaired growth among paediatrics confront both patients and their carers. Of concern, however, has been the variation and quality of study designs, which has made the report not only inconsistent but with weak evidence as well. The question still remains whether corticosteroid is disposable. We review corticosteroid use in transplant immunotherapy in the era of improved immunosuppression.

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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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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 We aimed to study the association of fibroblast growth factor-23 (FGF-23) with conventional cardiovascular risk factors in hemodialysis (HD) patients. Patients and methods This is a cross-sectional study, which was carried out on 90 HD patients. Demographic data were recorded in predefined data sheets. The blood samples for FGF-23 and other laboratory variables were collected and measured using the standard methods. The results and their relationships with FGF-23 were analyzed. Results In our study, there were insignificant correlations between FGF-23 and all clinical cardiovascular variables apart from a significant positive correlation between FGF-23 and systolic blood pressure (r=−0.546, P=0.004). Multivariate analysis failed to show any significant association between FGF-23 and systolic blood pressure (B=0.749, T=1.659, P=0.067). Conclusion Multiple linear regression analysis failed to show any significant association between FGF-23 and other conventional cardiovascular risk factors. We recommend using FGF-23 as an independent risk factor of cardiovascular morbidity and mortality, and searching for agents that control its level in HD patients.

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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 Chronic kidney disease is a universal escalating health issue of many etiologies. It affects millions across the world from all racial and ethnic groups. Objective The purpose of this study is to assess the influence of erythropoietin (EPO) therapy on glycated hemoglobin (HbA1c) levels while excluding conditions that cause changes in the blood glucose concentration. Patients and methods Clinical data were collected from 60 Egyptian patients with chronic kidney disease; of these, 30 patients had a history for diabetes mellitus and 30 nondiabetic controls. Serum urea, creatinine, complete blood count, fasting and postprandial blood glucose levels, and HbA1c were measured by means of column chromatography before and 3 months later after a course of recombinant EPO treatment for anemia. Results This study revealed that EPO medication had a significant effect on HbA1c levels, and the more erythropoiesis fluctuated by altering the dose of EPO, the more HbA1c levels changed, though there were no significant changes in blood glucose levels throughout the study period. The changes in HbA1c during the 3-month period were inversely correlated with the changes in Hb%. Conclusion The change in Hb% should be kept in mind when the HbA1c level is evaluated in EPO-treated patients and formula should be proposed to correct HbA1c levels based on the change in hematocrit or the reticulocyte count.

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End-stage renal disease is a growing health problem worldwide. Renal transplantation provides a better patient survival and quality of life compared with other means of renal replacement therapy. There is a serious shortage of transplantable kidneys, especially in countries where deceased donation is not allowed. Kidney paired donation (KPD) is a novel program applied to expand the donor pool, increase kidney transplantation rates, and allow a better donor recipient matching specially for sensitized patient. It permits living kidney transplantation in a short waiting time with better graft survival compared with those with deceased kidney transplantation. This review article aims to highlight the importance of KPD program as a promising solution for organ shortage and commercial transplantation. It also discusses the idea of implementing such programs in Egypt and offers future suggestions that may help its establishment.

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Background Nephrotic syndrome is not a disease; it is the manifestation of a wide variety of underlying disease processes. Objectives The aim of the present study was to investigate different clinic-laboratory and histological patterns of nephrotic syndrome and the relationship between its clinical character and prognosis. Methods From January 2010 to December 2011 the authors of the present study retrospectively and prospectively studied 139 patients with nephrotic syndrome, diagnosed on the basis of heavy proteinuria greater than 3 g/day, hypoalbuminemia, evidence of fluid retention or edema, and hyperlipidemia. Results A total of 139 patients (M : F = 79 : 60) were included in the present study; their mean age was 33.9 ± 13.47 years (primary : secondary nephrotic syndrome = 80 : 59). Systemic lupus erythematosus was the most common underlying cause of secondary nephrotic syndrome [24 cases (40.7%)], followed by DM [13 cases (23.7%)]. Renal biopsy revealed 18 patients (30.5%) with membranoproliferative glomerulonephritis, 15 (25.43%) with membranous nephropathy, seven (11.86%) with mesangial proliferative glomerulonephritis, six (10.16%) with amyloidosis, five (8.47%) with focal segmental glomerulosclerosis, three (5.08%) with diffuse proliferative glomerulonephritis, one (1.69%) with focal proliferative, minimal mesangial, sclerosing glomerulonephritides, one patient (1.69%) with crescent glomerulonephritis, and another one (1.69%) with IgA nephropathy. A raised serum creatinine level was found in 49 (35%) patients, and 35 (74.4%) of them had normal renal function at the last follow-up. Complete remission of proteinuria occurred in 69 (49.6%) patients, partial remission in 53 (38.1%), and resistant proteinuria in 17 (12.2%). Conclusion Clinical features and biochemical values do not give many clues about the underlying histological types of glomerulonephritis. Therefore, renal biopsy should be carried out in all patients with adult nephrotic syndrome, as results permit us to establish a specific diagnosis, which helps in counseling the patients about the likely prognosis of their disease and to select a specific therapeutic regimen.

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Objectives Thin basement membrane disease (TBMD) or benign familial hematuria is common in women. The median age is 37 years among adults. About two-third of the patients with TBMD have at least one other hematuric family member when five relatives are tested. Case report We hereby present a case of adult TBMD to clarify the clinicopathological characteristics of the disease in 56-year-old woman with long-standing intermittent dark colored urine with proteinuria, normal serum creatinine, and with normal blood pressure. Renal pathology showed normal renal tissue by using the light and immunofluorescence examination. Thinning of the glomerular basement membrane, ranging from 110 to 200 nm, was demonstrated by using electron microscopy. Conclusion Although it is part of routine nephropathology worldwide, electron microscopic examination of renal biopsies are rarely used in Egypt. This important diagnostic pillar should be more frequently used among our patients, especially when clinicopathologic diagnosis is unclear.

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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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