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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Diabetic patients are at risk of developing renal dysfunction as part of microvascular complications of diabetes mellitus, but they could develop renal dysfunction because of nondiabetic renal diseases as a result of glomerulopathy, either in primary or secondary forms (glomerulonephritis or vasculitis), or as part of tubulointerstitial involvement because of paraproteinemia. Here, we report on two diabetic patients who had different clinical profiles in terms of their diabetes type, clinical presentation, and decrease in renal dysfunction from the time of diagnosis of diabetes mellitus. A clinical scenario resulted in a delay in diagnosis and management, until a conclusive renal biopsy reported a definitive diagnosis, with implementation of therapeutic protocols and satisfactory outcomes in both patients.

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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: Medical information systems collect vast amount of monitored clinical data. Interpreting the portions of the data that are relevant to the identification of a specific clinical problem can become a hard task. Data mining are largely used in a very wide range of applications. Data mining mainly depends on mathematical algorithms and analytical skills to drive the desired results from the huge database sets and/or collections. Clustering is one of the most important data mining techniques. Most of the earlier work on clustering has focused on numerical relationships between the values of the attributes, and ignored the inherent meaning of the values. Aim: In this work, an enhancement is added to the k-means algorithm for clustering data. Material & Methods: Furthermore, modification of the difference values between the attributes was done. The proposed clustering technique has been used to improve the quality, efficiency of health services and decision making in hemodialysis centers. Long experimentations and heavy tests were done on a variety of clustered different attributes for hemodialysis patient information systems. Results: The results showed that, our enhancement on the k-means algorithm has realized a better maximum distance and separate values for each cluster lower than the traditional k-means algorithm. Conclusion: The decision making for the session period and blood rate has been improved and made more accurate. This provides the robust and best dialysis adequacy for the specific patient case.

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Background Diabetes mellitus type 2 (T2DM) is a metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. Vaspin (visceral adipose tissue-derived serpin) is a member of the broadly distributed serpin (a protein superfamily of serine protease inhibitors of ∼500 genes) and is identical to serpin A12. The upregulation of vaspin can improve insulin resistance. Thus, identification of the protease inhibited by vaspin may lead to the development of novel strategies in the treatment of diabetes and insulin resistance. In patients with chronic kidney disease, the levels of vaspin appear to increase mostly because of reduced renal metabolism of vaspin. Tumor necrosis factor-α (TNF-α) is a cytokine involved in systemic inflammation. Its increased production has been observed in adipose tissue, and it has been implicated as a causative factor in obesity-associated insulin resistance, the pathogenesis of T2DM, and the development of diabetic nephropathy (DN) through several mechanisms. The association of T2DM patients (with and without impaired renal function) with serum vaspin and TNF-α levels is not clearly understood. This study aimed to evaluate the levels of vaspin and tumor necrosis factor (TNF) in T2DM patients and compare their levels with impairment in renal function in T2DM to determine whether circulating vaspin and TNF could be a biomarker of DN. Patients and methods This case–control observational prospective study was conducted on 73 patients with T2DM classified into two groups; group I included 20 T2DM patients with reduced renal function, and group II included 53 T2DM patients with normal renal function. The studied groups were recruited from the Diabetic Unit Outpatient Clinic, Department of Internal Medicine, Sohag University Hospitals, from December 2014 to December 2015. T2DM was diagnosed according to the American Diabetes Association Criteria. Totally, 12 age and sex matched apparently healthy individuals who served as the control group (group III) were enrolled in the study. The study was approved by the ethical committee of Faculty of Medicine, Sohag University, and written informed consent was obtained from each participant. All participants were subjected to thorough history taking, full clinical examination, and anthropometric measurements, including weight, height, and BMI. In addition, peripheral hemogram, random blood glucose evaluation, HbA1c determination, liver function tests, kidney function tests, lipid profile, and serum vaspin and serum TNF-α evaluation were carried out. Results In essence, significant correlations of vaspin and TNF were found with age of T2DM patients, hypertension, BMI, and lipid profile, but not with HbA1c. Moreover, higher levels of vaspin and TNF-α were significantly correlated with the degree of impaired renal function in T2DM patients. Notably, multivariate linear regression shows that BMI and age are negatively correlated with vaspin but not with TNF-α levels in T2DM patient with more impaired renal function. Conclusion Strict monitoring of T2DM can reduce the morbidity and mortality rate and will also improve the quality of life of diabetic patients. The association of renal insufficiency due to diabetes mellitus with serum vaspin and TNF-α levels is not clearly understood. However, vaspin may be beneficial as a positive biomarker for T2DM patients with impaired renal function and can be considered as a new prognostic marker for DN. Large studies are required to establish vaspin and TNF-α efficacy and safety in T2DM.

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