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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Renal hyperparathyroidism is a common disease affecting the vast majority of chronic kidney disease (CKD) patients. With effective medical treatment, only 5-10% of CKD patients require surgical treatment. The medical treatment includes a wide variety of medications to replace the inactive vitamin D, suppress the hyperactive parathyroid glands and also to counteract the hyperphosphatemia. Based on publications from Egypt, the financial difficulties the CKD patients are suffering from does not allow the delivery of successful medical treatment. This is mainly due to the inability to use an effective and more expensive phosphate binder and active vitamin D (1). Also, calcimimetic therapy (e.g cinacalcet) is unaffordable and needs life-long administration. This has led to an increased prevalence of the florid disease compared to developed countries (2). The situation was made worse by the lack of understanding of the principles of diagnosis and surgical treatment of renal hyperparathyroidism among many clinicians. Surgeons rely mainly on imaging in the localization of the hyperplastic glands, which is well known to be not sensitive enough in this multi-gland disease (3). This often led to inadequate surgical management of this disease. Also, the multicentric nature of this condition (multi-gland, rather than a single-gland disease) is often undermined. The published reports from Egypt showed only a few centres dealing with this disease; however the number of patients reported is quite small with variable outcomes (4). The reported outcome demonstrates that more patients require surgery for the poorly controlled hyperparathyroidism that unmasks the lack of appropriate surgical experience in many district areas of Egypt.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Renal disease is a common health problem that is linked to excessive morbidity and mortality worldwide. It is crucial to know the etiology and clinical features of renal diseases to promote prevention strategies and adequate management resources. This study aimed to perform a comprehensive review the spectrum of renal diseases among patients admitted to one internal medicine unit (unit 6) through the emergency room. We evaluated total admission cases to the unit 6 through the emergency room in 1 year between July 2010 and July 2011. The total capacity of the unit is 24 beds. The total number of patients admitted during the study period was 571. Their mean age was 50.72 ΁ 14.15 years (range 14-95 years). A total of 51.66% were males and 48.44% were females. The average duration of hospital stay was 6.43 ΁ 3.57 days (range 1-30 days). There were 200 patients with renal diseases (35.02%). Their mean age was 46.73 ΁ 15.76 years (range 16-87 years). In all, 55% were females and 45% were males, and the average duration of hospital stay was 7.59 ΁ 3.89 days (range 1-23 days). In all, 33% of patients had acute kidney injury represented, 51.5% had chronic kidney disease, 7.5% had glomerular diseases (nephrotic and nephritic syndromes), and 8% had obstructive uropathy. Fifteen patients died during their hospital stay (7.5%); their average age was 49.87 ΁ 11.42 years (range 28-65 years). There were four statistically significant mortality predictors among patients with kidney diseases (total leukocyte count above 19.55 cm ² , serum potassium above 5.74 mEq/l, atrial fibrillation, and hypertension). The total cost of services provided for patients was 275 624 L.E. The total cost of services provided for patients with kidney diseases was 118 919.25 L.E. (43.15%).

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Diabetes is now the major cause of end-stage renal failure worldwide, both in developing and in developed nations. Hyperglycemia is still considered the principal cause of complications of diabetes because of the formation of sugar-derived substances called advanced glycation end products. The formation of advanced glycation end product is markedly accelerated in diabetes because of the increased availability of glucose. The receptor for advanced glycation end products (RAGE) has been shown to be involved in the pathogenesis of diabetic complications. The aim of this work was to assess the possible association between soluble receptor for advanced glycation end products (sRAGE) and urinary albumin excretion in type 2 diabetic patients as an early predictor of microvascular complications such as diabetic nephropathy. The present study was carried on 70 individuals: 10 healthy individuals as control, 20 diabetic patients with normoalbuminuria, 20 diabetic patients with microalbuminuria, and 20 diabetic patients with macroalbuminuria. All participants were subjected to estimation of sRAGE by the sandwich enzyme-linked immunosorbent assay technique together with routine laboratory investigations. The results of this study showed that all diabetic patients had a low level of serum RAGE compared with the control group. Furthermore, a characteristic trend was observed whereas three groups of diabetic patients showed a decrease in RAGE in parallel with the severity of renal involvement. From this point of view, stimulation of sRAGE production should be considered a potential therapeutic target in diabetic patients.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]