The level of C-reactive protein in chronic hemodialysis patients: A comparative study between patients with noninfected catheters and arteriovenous fistula in two large Gulf hemodialysis centers.
Journal - Hemodialysis international. International Symposium on Home Hemodialysis
Hemodialysis (HD) patients have greater morbidity and mortality when they have a central venous catheter (CVC) rather than an arteriovenous fistula (AVF) access. Inflammation associated with dialysis catheter use and resultant higher C-reactive protein (CRP) levels could have an independent adverse effect on patient outcomes. In this prospective study, we investigated whether HD catheters induce inflammation independent of infection. We compared the mean levels of the inflammatory marker (CRP) in 67 patients on maintenance HD using noninfected catheters with 86 HD patients using AVFs at Prince Salman Center for Kidney Diseases, Saudi Arabia (KSA), and Jahra Hospital, Kuwait, who met our inclusion criteria. C-reactive protein levels were measured every 2 months over a period of 6 months using immunoturbidimetric assay. One hundred fifty-three patients on maintenance HD for more than 6 months were included in the study, with mean age of 52.19?±?16.06 years; 66% were males and 34% were females. Serial levels of mean CRP were statistically and significantly higher in group with noninfected catheters (1.33, 1.24, and 1.10?mg/dL) compared to those with AVFs (0.65, 0.59, and 0.68?mg/dL) with P value of 0.000. In our study, we found no relation between CRP level and age, sex, hemoglobin, albumin, calcium, phosphorus, and iPTH level in both groups. Hemodialysis patients with a catheter have a heightened state of inflammation independent of infection, and thus our study supports the avoidance of catheters and a timely conversion to AVFs with catheter removal.© 2014 International Society for Hemodialysis.
|ISSN : ||1542-4758|
|Keywords : ||CRP access hemodialysis inflammation|
Sleep disorders in hemodialysis patients.
Journal - Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia (Saudi Arabia )
The prevalence of sleep disorders is higher in patients with kidney failure than the general population. We studied the prevalence of sleep disorders in 88 (mean age; 41.59 +/- 16.3 years) chronic hemodialysis (HD) patients at the Urology and Nephrology Center, Mansoura Uni-versity, Egypt over 4-month period. The investigated sleep disorders included insomnia, restless leg syndrome (RLS), obstructive sleep apnea syndrome (OSAS), excessive daytime sleepiness (EDS), narcolepsy and sleep walking, and we used a questionnaire in accordance with those of the International Restless Legs Syndrome Study Group, the Berlin questionnaire, Italian version of Epworth Sleepiness Scale, International Classification of Sleep Disorders, and the specific ques-tions of Hatoum's sleep questionnaire. The prevalence of sleep disorders was 79.5% in our pa-tients, and the most common sleep abnormality was insomnia (65.9%), followed by RLS (42%), OSAS (31.8%), snoring (27.3%), EDS (27.3%), narcolepsy (15.9%), and sleep walking (3.4%). Insomnia correlated with anemia (r=0.31, P= 0.003), anxiety (r=0.279, P= 0.042), depression (r=0.298, P= 0.24) and RLS (r=0.327, P= 0.002). Also, RLS correlated with hypoalbuminemia (r=0.41, P= < 0.0001), anemia (r=0.301 and P= 0.046), hyperphosphatemia (r=0.343 and P= 0.001). EDS correlated with OSAS (r=0.5, P= < 0.0001), snoring (r=0.341, P= 0.001), and social worry (r=0.27, P= 0.011). Sleep disorders are quite common in the HD patients, especially those who are anemic and hypoalbuminemic. Assessment of sleep quality, preferably with polysomno-graphy, is necessary to confirm our results. Interventional studies for management of sleep disor-ders in HD patients are warranted.
The role of oral L-Carnitine therapy in chronic hemodialysis patients.
Journal - Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia (Saudi Arabia )
To evaluate the effects of L-carnitine oral supplementation on anemia and cardiac function in patients on maintenance hemodialysis (HD), we studied 55 adult chronic HD patients at our center during the period from January 2006 to June 2006 and divided them into two groups; a group of 20 patients who received 1,500 mg/day oral L-carnitine and a control group of 35 patients. Both groups were on erythropoietin therapy. Echogardiographic studies were performed before and at the end of the study. The mean hemoglobin levels were comparable in the L--carnitine group and the control group at the start and after 6 months of therapy (8.63 +/- 1.77 and 9.39 +/- 2.02 gm/dL, P= 0.18; 10.49 +/- 1.65 and 10.92 +/- 2.48 gm/dL, P= 0.76, respectively). The mean weekly maintenance dose of erythropoietin was not statistically significantly different in L-carnitine group (80.16 +/- 35.61 units/kg) and the control group (91.9 +/- 38.21 units/kg, P= 0.20). In addition no significant improvement could be observed in the echogardiographic findings in the L-carnitine group after therapy. We conclude that our study revealed no significant improvement in hemoglobin, erythropoietin dose and echocardiographic findings after six months of therapy. Long-term studies including larger number of patients are required to clarify the questionable role of L-carnitine in the HD patients.
Proteinuria among renal transplant patients and its relation to hepatitis C virus and graft outcome: a single center experience.
Journal - Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation (Turkey )
Objectives: Chronic hepatitis C virus has been associated with glomerular disease in native and transplanted kidneys. Reports suggest that hepatitis C virus-infected renal recipients may develop de novo glomerulonephritis. We evaluated the presence of hepatitis C virus at transplant, the occurrence of proteinuria in Egyptian renal transplant patients, and its possible link with graft survival. Materials and Methods: Three hundred seventeen patients with end-stage renal disease receiving transplants in Mansoura Urology and Nephrology Center were retrospectively evaluated between 2000 and 2003. Their sera were assayed for anti-hepatitis C virus antibodies at transplant. The relation between hepatitis C virus and development of posttransplant proteinuria was evaluated, along with possible effects of proteinuria on long-term graft survival. Results: Two hundred seventy-three recipients fulfilled the inclusion criteria, 169 were positive and 104 were negative for hepatitis C virus-antibodies by ELISA. Mean duration of posttransplant follow-up was 87.73 +/- 26.79 and 84.29 +/- 28.55 months for both groups. Groups were comparable regarding the incidence and quantity of hepatitis C virus positive patients and 0.4 g/d (P = .09 of proteinuria). In both hepatitis C virus-positive and negative groups, those with nephrotic range proteinuria showed worse graft survival (P = .001) and higher frequency of chronic allograft nephropathy (P = .05) compared with nonproteinuric patients. Conclusions: There is a high prevalence of hepatitis C virus in our end-stage renal disease patients awaiting renal transplant. The incidence and quantity of proteinuria is similar in both hepatitis C virus-positive and hepatitis C virus-negative transplant recipients. Nephrotic range proteinuria is associated significantly with a higher incidence of chronic allograft nephropathy. Independent from serology, it is associated with poorer graft outcome.
Proteinuria after kidney transplantation: its relation to hepatitis C virus and graft outcome.
Journal - Iranian journal of kidney diseases (Iran )
INTRODUCTION: Chronic Hepatitis C Virus (HCV) infection has been associated with glomerular disease in native and transplanted kidneys. We evaluated the presence of HCV infection at the time of transplantation and occurrence of proteinuria in Egyptian kidney transplant patients and their link with graft survival. MATERIALS AND METHODS: This retrospective study was done on 273 patients with end-stage renal disease transplanted in Mansoura Urology and Nephrology Center Between 1993 and 1996. Their sera were routinely assayed for anti-HCV antibodies at the time of transplantation. The relationship between the HCV and the development of posttransplantation proteinuria was evaluated, along with the possible effects of proteinuria on long-term graft survival. RESULTS: A total of 169 kidney recipients (61.9%) were positive for anti-HCV antibodies. The mean durations of post-transplant follow-ups were 87.73 +/- 26.79 months (range, 19 to 123 months) and 84.29 +/- 28.55 months (range, 11 to 123 months) for the patients with and without anti-HCV antibodies, respectively. The patients in these groups were comparable regarding the incidence of proteinuria (33% and 32%, respectively) and its quantity (median, 0.6 g/d and 0.4 g/d, respectively). Irrespective of the HCV infection, patients with nephrotic-range proteinuria showed a worse graft survival (P < .001) and a higher frequency of chronic allograft nephropathy (P = .03) compared with nonproteinuric patients. CONCLUSIONS: There is a high prevalence of HCV infection in our patients with end-stage renal disease awaiting kidney transplantation. The incidence and quantity of proteinuria do not increase by HCV infection, and nephrotic-range proteinuria is independently associated with chronic allograft nephropathy and a poorer graft outcome.
|ISSN : ||1735-8582|
|Mesh Heading : ||Adult Cohort Studies Egypt Female Graft Survival Hepatitis C Antibodies Hepatitis C, Chronic Humans Kidney Failure, Chronic Kidney Transplantation Male Prevalence Prognosis Proteinuria Retrospective Studies Young Adult epidemiology immunology epidemiology immunology surgery|
|Mesh Heading Relevant : ||blood complications complications adverse effects complications|
A comparative study of two intensified pulse cyclophosphamide remission-inducing regimens for diffuse proliferative lupus nephritis: an Egyptian experience.
Journal - International urology and nephrology
INTRODUCTION: Lupus nephritis (LN) is a severe manifestation of systemic lupus erythematosus (SLE) that is usually treated with an extended course of intravenous (IV) cyclophosphamide (CYC). Given the side effects of this regimen, we evaluated the short-term efficacy and toxicity of a course of low-dose remission-inducing IV CYC followed by azathioprine (AZA) in a prospective controlled study among Egyptian patients with severe LN. PATIENTS AND METHODS: In this single center, prospective clinical trial, we assigned 46 SLE patients with diffuse proliferative glomerulonephritis to either a high-dose (a maximum of 1 g/dose) of IV CYC (HD-CYC) for six monthly pulses followed by two quarterly pulses or a fixed low-dose (500 mg/dose) of IV CYC (LD-CYC) for six fortnightly pulses with a cumulative dose of 3 g. Each regimen was followed by AZA. THE OBJECTIVE: To compare between efficacy, potential toxicity and outcome of parenteral LD-CYC versus HD-CYC therapy for severe LN. RESULTS: Twenty patients (2 male and 18 female) received fortnightly fixed LD-CYC while 26 (5 male and 21 female) received monthly HD-CYC therapy. At the end of the study (1 year after starting therapy), there was no difference either in patients' or in renal survival in both groups. Significant improvement of disease activity (SLE disease activity index) as well as rise of serum albumin was noticed with both regimens. Renal relapse was observed in 11.5% of HD-CYC patients and in none of the LD-CYC therapy patients. Treatment failure was seen in 5% and 3.4% (P = NS) of LD-CYC and HD-CYC patients, respectively. Infection (pneumonia and cellulitis) occurred in five patients in the LD-CYC group and four patients of HD-CYC; again this difference was not statistically significant. CONCLUSION: A remission-inducing regimen of LD-CYC (cumulative dose 3 g) followed by AZA for SLE patients with proliferative LN achieves clinical results comparable to those obtained with HD-CYC without serious infection in both regimens.
Co-administration of ketoconazole and tacrolimus therapy: a transplanted rat model.
Journal - International urology and nephrology (Hungary )
BACKGROUND/AIM: The aim of this work is to study the effect of addition of ketoconazole to experimental kidney transplanted rat treated with tacrolimus and precludes the percentage of tacrolimus dose reduction. MATERIAL AND METHODS: The material of this work included 60 male Sprague Dawely rats subjected to renal allotransplantation. They were equally divided into five groups: Group I: served as control group, Group II: received FK506 3.2 mg/kg/bw, Group III: received FK506 2 mg/kg/bw, Group IV: received FK506 1 mg/kg/bw, Group V: received FK506 1 mg/kg/bw plus ketoconazole 20 mg/kg/day. FK506 trough level and laboratory investigations were determined at 0, 3, 7, 10, 14, and 27 days post-transplantation. RESULTS: In all groups loss of body weight was observed at day 27 after treatment compared to that before transplantation. Serum creatinine significantly increased at day 27 compared to the basal level in groups treated with 1.0 mg and 3.2 mg FK506 (1.80+/-0.50 vs. 0.39+/-0.06 P=0.001) and (1.03+/-0.26 vs. 0.50+/-0.07 P=0.001) respectively. While for 2.0 mg or 1.0 mg plus keto groups, no significant differences in serum creatinine levels over time (0.56+/-0.22 vs. 0.44+/-0.10 P=0.106) and (0.55+/-0.30 vs. 0.42+/-0.08 P=0.160) were observed. CONCLUSION: Concomitant administration of ketoconazole and FK506 is safe and results in increase blood trough level concentration of FK506 with 50% dose reduction in transplanted rat model.
|ISSN : ||0301-1623|
|Mesh Heading : ||Animals Immunosuppressive Agents Ketoconazole Male Rats Rats, Sprague-Dawley Tacrolimus|
|Mesh Heading Relevant : ||administration & dosage administration & dosage administration & dosage|
Is sirolimus a nephrotoxic drug? A report of five cases.
Journal - Transplantation proceedings (United States )
|ISSN : ||0041-1345|
|Mesh Heading : ||Adult Humans Immunosuppressive Agents Kidney Failure, Chronic Kidney Glomerulus Kidney Transplantation Male Sirolimus adverse effects therapeutic use drug effects pathology therapeutic use|
|Mesh Heading Relevant : ||surgery immunology pathology adverse effects|
Colchicine vs. omega-3 fatty acids for prevention of chronic cyclosporine nephrotoxicity in Sprague Dawley rats: an experimental animal model.
Journal - Archives of medical research (United States )
BACKGROUND: In view of the high cost of the new immunosuppressive drugs, which represents a challenge for both patients and governmental resources especially in developing countries, trials to prevent side effects of the first calcineurin inhibitor discovered (cyclosporine, Cs) are of particular interest. METHODS: In this prospective randomized experimental study, 60 male Sprague Dawley rats were enrolled. Group 1 served as negative control group and received olive oil. Group 2 received Cs orally 100 mg/kg for 80 days and served as positive control group. Group 3 was given daily colchicine (30 microg/kg/day) in addition to Cs. Group 4 was given omega-3 fatty acids (100 mg/kg/day) in addition to Cs. Animals were subjected every other week to laboratory assessment for serum creatinine, sodium, potassium, and Cs whole-blood through levels. At the end point, the animals were sacrificed, and kidney tissue was examined for histopathological changes. RESULTS: There were no significant differences in serum creatinine, creatinine clearance, and serum sodium and potassium in all groups. Histopathological examination of kidney tissues showed focal tubular atrophy and interstitial fibrosis in inner medulla and inner strip of the outer medulla in all Cs-treated animals. Morphological changes were significantly less in colchicine-treated rats compared to omega-3 fatty acid-treated rats and absent in the negative control group. Furthermore, immunostaining showed positive reactions for vimentin in Cs-treated animals only. CONCLUSIONS: Colchicine and omega-3 fatty acids are protective for the kidney against cyclosporine-induced nephropathy; however, colchicine is more protective than omega-3 fatty acid.
|ISSN : ||0188-4409|
|Mesh Heading : ||Animals Colchicine Creatinine Cyclosporine Fatty Acids, Omega-3 Immunosuppressive Agents Kidney Male Potassium Rats Rats, Sprague-Dawley Renal Insufficiency, Chronic Sodium Tubulin Modulators Vimentin blood chemistry pathology blood chemically induced pathology blood analysis|
|Mesh Heading Relevant : ||therapeutic use toxicity therapeutic use toxicity prevention & control therapeutic use|
HCV associated glomerulopathy in Egyptian patients: clinicopathological analysis.
Journal - Virology (United States )
BACKGROUND: Hepatitis C virus (HCV) infection in Egypt has reached an epidemic proportion and is associated with many extra hepatic manifestations; Glomerulonephritis (GN) is one of the most consequences of HCV infection often resulting in end stage renal disease in some cases. Detection of viral genome or particles within the kidney biopsies from HCV-infected patients has proven to be difficult. Histological characterization of renal lesions still represents a major challenge. The aim of our work was to describe the histological pattern of HCV-associated nephropathy. METHODS: Fifty Patients--out of 233--presented to Mansoura Urology and Nephrology clinic with manifestations of glomerular disease were screened for HCV antibodies by a 3rd generation ELISA test. Those tested positive for HCV antibodies were confirmed by PCR for HCV-RNA and subjected to more detailed clinical, biochemical and histological study. Kidney biopsies and in appropriate cases liver biopsies were examined by LM and electron microscopy (EM). RESULTS: Histological study of renal biopsies revealed membranoproliferative (MPGN) type 1 to be the most common lesion encountered (54%), followed by focal segmental glomerulosclerosis (FSGS) (24%), mesangioproliferative GN (18%), membranous nephropathy (MN) (4%) in that order. EM examinations of renal biopsies were successful in identifying HCV like particles in frozen renal tissue. CONCLUSION: HCV-associated glomerulopathy is a distinct category of glomerulonephritis. Results of LM showed some peculiar features. In addition, we were successful in location and detection of HCV particles in renal tissues by EM.
|ISSN : ||0042-6822|
|Mesh Heading : ||Adult Base Sequence DNA, Viral Egypt Female Glomerulonephritis Hepacivirus Hepatitis C Humans Kidney Male Microscopy, Electron Middle Aged Polymerase Chain Reaction genetics isolation & purification epidemiology virology genetics isolation & purification ultrastructure epidemiology pathology virology pathology virology|
|Mesh Heading Relevant : ||etiology pathology complications|
Histological characterization of HCV-associated glomerulopathy in Egyptian patients.
Journal - International urology and nephrology (Hungary )
BACKGROUND: HCV infection in Egypt has reached epidemic proportion, it is associated with many extra hepatic manifestations. Glomerulonephritis (GN) is one of the most serious ending in renal failure in some cases. Detection of viral genome or particles within the kidneys of HCV-infected patients proved to be difficult. Histological characterization of renal lesions still represents a major challenge. The aim of our work was to describe the histological patterns of HCV-associated nephropathy. METHODS: Fifty patients--out of 233 presented to Mansoura Urology and Nephrology clinic with manifestations of glomerular disease were screened for HCV antibodies by 3rd generation ELISA test-, those proved positive for HCV antibodies were confirmed by PCR for HCV RNA and were thoroughly investigated regarding clinical, biochemical, histological criteria's of HCV-associated nephropathy. Kidney and liver biopsies were examined by LM and electron microscopy. RESULTS: Histological study of renal biopsies revealed membranoproliferative (MPGN) type 1 to be the commonest lesion encountered (54), followed by focal segmental glomerulosclerosis (FSGS) (24), mesangioproliferative GN (18), membranous nephropathy (MN) (4) in that order. Electron microscopic examinations of renal biopsies were successful in identifying HCV-like particles in frozen renal tissue. CONCLUSION: HCV-associated glomeruloapthy is a distinct category of glomerulonephritis, by LM it has some peculiar features, we were successful in localization of HCV particles in renal tissues by EM.
|ISSN : ||0301-1623|
|Mesh Heading : ||Adult Egypt Female Hepatitis C Humans Kidney Glomerulus Male Middle Aged|
|Mesh Heading Relevant : ||complications pathology pathology virology|
Relating circulating thyroid hormone concentrations to serum interleukins-6 and -10 in association with non-thyroidal illnesses including chronic renal insufficiency
Journal - BMC Endocrine Disorders
BackgroundBecause of the possible role of cytokines including interleukins (IL) in systemic non-thyroidal illnesses' (NTI) pathogenesis and consequently the frequently associated alterations in thyroid hormone (TH) concentrations constituting the euthyroid sick syndrome (ESS), we aimed in this research to elucidate the possible relation between IL-6 & IL-10 and any documented ESS in a cohort of patients with NTI.MethodsSixty patients and twenty healthy volunteers were recruited. The patients were subdivided into three subgroups depending on their underlying NTI and included 20 patients with chronic renal insufficiency (CRI), congestive heart failure (CHF), and ICU patients with myocardial infarction (MI). Determination of the circulating serum levels of IL-6 and IL-10, thyroid stimulating hormone (TSH), as well as total T4 and T3 was carried out.ResultsIn the whole group of patients, we detected a significantly lower T3 and T4 levels compared to control subjects (0.938 ± 0.477 vs 1.345 ± 0.44 nmol/L, p = 0.001 and 47.9 ± 28.41 vs 108 ± 19.49 nmol/L, p < 0.0001 respectively) while the TSH level was normal (1.08+0.518 µIU/L). Further, IL-6 was substantially higher above controls' levels (105.18 ± 72.01 vs 3.35 ± 1.18 ng/L, p < 0.00001) and correlated negatively with both T3 and T4 (r = -0.620, p < 0.0001 & -0.267, p < 0.001, respectively). Similarly was IL-10 level (74.13 ± 52.99 vs 2.64 ± 0.92 ng/ml, p < 0.00001) that correlated negatively with T3 (r = -0.512, p < 0.0001) but not T4. Interestingly, both interleukins correlated positively (r = 0.770, p = <0.001). Moreover, IL-6 (R2 = 0.338, p = 0.001) and not IL-10 was a predictor of low T3 levels with only a borderline significance for T4 (R2 = 0.082, p = 0.071).By subgroup analysis, the proportion of patients with subnormal T3, T4, and TSH levels was highest in the MI patients (70%, 70%, and 72%, respectively) who displayed the greatest IL-6 and IL-10 concentrations (192.5 ± 45.1 ng/L & 122.95 ± 46.1 ng/L, respectively) compared with CHF (82.95 ± 28.9 ng/L & 69.05 ± 44.0 ng/L, respectively) and CRI patients (40.05 ± 28.9 ng/L & 30.4 ± 10.6 ng/L, respectively). Surprisingly, CRI patients showed the least disturbance in IL-6 and IL-10 despite the lower levels of T3, T4, and TSH in a higher proportion of them compared to CHF patients (40%, 45%, & 26% vs 35%, 25%, & 18%, respectively).Conclusionthe high prevalence of ESS we detected in NTI including CRI may be linked to IL-6 and IL-10 alterations. Further, perturbation of IL-6 and not IL-10 might be involved in ESS pathogenesis although it is not the only key player as suggested by our findings in CRI.
Pregnancy in dialysis patients: a case series
Journal - Journal of Medical Case Reports
Fertility is markedly reduced in patients with chronic renal failure. For women with pre-existing renal disease, pregnancy is associated with an increased rate of fetal complications and a considerable risk of renal disease progression. Due to substantial improvements in antenatal and neonatal care, fetal outcome has improved considerably in the last two decade.A Saudi survey which examined the frequency of pregnancy among women in end stage renal disease (ESRD) and undergoing regular hemodialysis (HD), showed an incidence of 7% over a five year period (1.4 per year). This may reflect the cultural endorsement of having offspring.We hereby report 2 cases of successful pregnancy managed at the Prince Salman Center for Kidney Diseases (PSCKD).