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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Aim/Objectives/Background Systemic Lupus Erythematosis (SLE) is a systemic autoimmune disease affects multiple organs with clinically heterogeneous outcomes. Lupus Nephritis (LN) is a common complication of systemic lupus erythematosus, and it occurs in 31–65% of SLE patients. kidney transplantation is the best long-term option for patients with End Stage renal Disease. The aim of this work is then to assess the patient and graft outcome for those who reached end stage renal disease and received kidney transplantation at urology and nephrology center, mansoura university. Subjects and Methods The material of this section include 23 kidney transplant recipients due to lupus nephritis. A 46 matched kidney transplant patients who were diagnosed as end stage renal disease due to other causes will serve as control group. Results and Conclusions Results of the study showed no difference in patient and graft outcome between kidney transplant recipients due to lupus nephritis and kidney transplant recipients due to other causes. The risk of recurrence of lupus nephritis in the graft is very low if compared with FSGS or MPGN. We concluded that kidney transplantation for lupus patients is safe and carries no risk for lower patient or graft survival. The risk of recurrence is much lower if compared with other glomerular diseases.

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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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The most common urological complication after renal transplantation is ureteral obstruction. Traditionally, open surgical reconstruction was often the preferred method for correcting this problem. Today, a number of minimally invasive techniques are available to treat these complications. We report a case of early post-transplant ureteric obstruction at the vesicoureteric junction managed by endourologic procedures.

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Background β₂-Microglobulin (β₂-MG) is a uremic toxin that is retained in patients with end-stage renal disease. Interleukin-6 (IL-6) besides being an inflammatory marker has emerged as an independent predictor of mortality in end-stage renal disease patients. Objectives The aim of the present study was to investigate the effect of online haemodiafiltration (OL-HDF) by one session per week on the serum level of both IL-6 and β₂-MG and to evaluate its effect on the changes in nerve conduction in patients on chronic haemodialysis (HD). Patients and methods Sixty patients on regular conventional HD for more than 5 years were subjected to one session of OL-HDF by using the ‘Gambro AK 200 ULTRA’ system for 4 h and two sessions of HD for 4 h per week with a follow-up for 3 months. Furthermore, urea reduction ratio was measured during one HD and one HDF session, serum β₂-MG and IL-6 reduction ratio were measured during one HD and one HDF session, and during follow-up, the serum β₂-MG level and IL-6 level were measured at four time intervals. Nerve Conduction Study (NCS) was done at the start of the HDF treatment and follow up 3 months post HDF treatment. Results Urea reduction ratio% was significantly higher with HDF than with HD (75.6 vs. 66.9%) and this difference was statistically significant (P<0.001). Reduction ratio of β₂-MG level was 72.2% with HDF versus 26.6% with HD and this difference was statistically significant (P<0.001). The results of motor conductivity testing showed significantly higher nerve conduction velocity in post-HDF in comparison with pre-HDF in right median nerve (P<0.001) and in left peroneal nerve (P<0.001). The mean value of sensory response in amplitude as well as in nerve conduction velocity in right median nerve and left median nerve were significantly higher after HDF treatment period (P<0.05). Conclusion The OL-HDF had a good effect on clearance of β₂-MG at the level of one session, at the level of follow-up for 3 months, the serum level of β₂-MG did not significantly changed. Also improvement in some aspects of nerve conduction, but the level of IL-6 in OL-HDF increase.

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