Prevalence of chronic kidney diseases in rural areas in Assiut district

Chronic kidney disease [CKD] is increasingly recognized as a global public health problem. Currently, CKD is the 12[th] highest cause of death and 17[th] highest cause of disability worldwide. To determine the prevalence of chronic kidney diseases in rural areas in Assiut District, prevalence of most common risk factors for CKD and the relation between these risk factors and CKD in the studied group Two villages out of 15 villages from Assiut district were randomly selected; El Bora and Awlad Rayek. Sample size was calculated using EPI info 2000 statistical calculation version 6 which revealed that we should have sample size not less than 235 participants. All candidates were interviewed in a previously prepared questionnaire. Blood pressure measured, morning urine samples were obtained, and blood samples were withdrawn for kidney function and blood glucose level. Prevalence of chronic kidney diseases [stage 1-4] in rural areas of Assiut District is high 27.6%, prevalence of hypertension, diabetes, recurrent urinary tract infection, past history of bilharziasis and renal stones in the studied sample as follow: 15.5%, 13.2%, 12.6%, 8.9%, 6.9%; respectively. Hypertension and diabetes had high association with cases of CKD in the studied sample. It seems that there is a high prevalence of chronic kidney disease in our locality; but unfortunately little awareness about chronic kidney diseases. Hypertension and diabetes had high association with cases of CKD in the studied group

Serum leptin, insulin and parathyroid hormone levels in chronic renal failure patients

Chronic renal failure patients whether they are treated with hemodialysis or on conservative treatment frequently suffer uremic anorexia and malnutrition, which is associated with increased morbidity and mortality. In this study we have measured serum leptin, serum insulin and parathyroid hormone in addition to routine kidney function tests, serum glucose, total protein, albumin, lipogram, total serum calcium and inorganic phosphorus. This study was conducted on forty five male patients with chronic renal failure and ten healthy male subjects as control group [Group I.]. According to management of chronic renal failure the patients were divided into two groups: 22 patients on conservative treatment [Group II] and 23 patients on hemodialysis [Group III]. Serum levels of both leptin and insulin revealed significant elevation in patient groups [either on conservative or on hemodialysis,] compared to controls, also in hemodialysis group compared to group on conservative treatment. Serum level of intact parathyroid hormone, also showed significant elevation in groups II and III compared to controls with no difference in comparing group Ill versus group II. Correlation study in whole patients group revealed significant negative correlations between creatinine clearance with both leptin and insulin. Also significant positive correlations were found between leptin and insulin and between leptin and intact parathyroid hormone [iPTH]. Anorexia was found in both patient groups II and III [90.9% and 91.3% respectively,]. Chronic renal failure patients have hyperleptinemia and hyperinsulinemia and there are important interactions between leptin and insulin in which each hormone may be involved in regulating the function of the other. Excess parathyroid hormone may play a role in the pathogenesis of both hyperleptinemia and hyperinsulinemia. Hyperleptinemia may be an important contributing factor for uremic anorexia

Erectile dysfunction in chronic renal failure patients undergoing haemodialysis

In this study, 75 patients were subjected to clinical and laboratory investigations. Age, presence of hypertension, smoking history of ischemic heart disease and duration of dialysis were detected. Hemoglobin level, creatinine level, blood urea, albumin and glucose were evaluated. A control group of 148 healthy males, representing the general Egyptian population, was also included in the study. In view of the observed high prevalence of erectile dysfunction [ED] among hemodialysis [HD] patients, it was suggested that a complete health evaluation of male HD patients should include a discussion about erectile function in the standard clinical care program of patients with renal disease

Survey study of microalbuminuria in diabetic patients attending out-patient clinic of diabetes in Assiut University Hospital

Micro albuminuria is the earliest sign of diabetic nephropathy [DNP] and it is an indicator for the presence of the characteristic glomerular lesion. This study was conducted on the adult diabetic patients of both types I and II of diabetes mellitus [DM] attending the out -patient clinic of Assiut University Hospital throughout the year 2002. Patients with hypertension, congestive heart failure or those with urinary tract infection albuminuria were excluded. Five hundred patients were subjected to full history taking and clinical examination as well as the following investigations; [I] complete urine analysis [2] screening for micro albuminuria [3] fasting serum glucose [FSG]] and glycosylated hemoglobin [HbAlc] [4] serum urea and creatinine and creatinine clearance. Out of 500 patients 213 [42.6%] were positive for micro albuminuria which was more prevalent among type I DM, male sex, extreems of age, urbans, over-weight and obese patients and those with low physical activities as well as patients with non renal complications. Significant direct proportions were found between level of micro albuminuria, on one hand, and level of FSG and HbAlc and serum urea and creatinine on the other hand, while inverse proportion was found with creatinine clearance. We have concluded that, micro albuminuria is a simple detectable marker for screening incipient DNP. Micralbuminuria was prevalent among considerable percentage [42.6%] of our diabetic patients. It was found to be more prevalent among different studied categories of patients which could be considered as possible risk factors for developing DNP in our locality. Apart from hypertension, these factors are [1] type I DM [2] male sex [3] extreems of age [4] urbans [5] low physical activities [6] obesity [7] long duration of DM [8] bad control of hyperglycaemia [9] presence of non renal complications [10] renal insufficiency

superadded value of magnetic resonance angiography in evaluation of renal artery stenosis

The aim of this work was to study the optimal techniques, applications, limitations and value of magnetic resonance angiography [MRA] in the diagnosis of renovascular hypertension, using digital subtraction angiography [DSA] as the standard procedure in most of the cases. Fifty-five patients were included in this study; all referred from Nephrology Unit for the clinical suspicion of renovascular hypertension. Ultrasonography [US] including Doppler [CDUS] examination was done to exclude renal parenchymal disease. Breath hold gadolinium enhanced MRA for renal arteries, followed by three dimensional phase contrast angiography [3D PCA] maximum intensity projection [MIP] reformatting images were done in axial and oblique directions. The study concluded that MRA is a sensitive procedure [100%] in the diagnosis of main renal artery stenosis, particularly those with significant stenosis near 50% stenosis. MRA is also a sensitive procedure in the following up patients with previous intravascular procedure and for the vascular assessment of transplanted kidneys

Right and left ventricular dysfunction and interaction in respiratory critically ill patients

This study was designed to determine the incidence of right ventricular [RV] and left ventricular [LV] dysfunctions and to relate the findings to possible mechanisms of interdependence between right and left ventricles during acute respiratory failure [ARF] in patients with chronic obstructive lung diseases [COLDs]. 58 hospitalized patients underwent pulmonary function tests and arterial blood gases. An echo-Doppler examination was performed for patients and 20-healthy subjects as control group to measure RV and LV end-diastolic and end-systolic diameters; RV and LV ejection fraction [EF], transmitral early [E] and late [A] peak flow velocities and their ratio [E/A]; isovolumic relaxation time [IRT]; trans-tricuspid early [E1] and late [A1] peak flow velocities and their ratio [E1/A1] and estimation of pulmonary artery pressure [PAP] by acceleration time [ACT] of the pulmonary systolic flow and tricuspid regurgitation [TR] jet velocity. The data showed dilated RV in 80% [50/58]; mild TR in 64% [37/58]; RV systolic dysfunction [EF<45%] in 28% [16/58] and RV diastolic dysfunction [decreased E1/A1 ratio] in 53% [31/58] of patients. On the other hand, LV systolic dysfunction [EF<45%] was found in 16% [9/58] of patients while LV diastolic dysfunction [low E, low E/A ratio and high IRT] in 72% [42/58] of patients. A linear regression analysis revealed that low E and low E/A ratio were significantly correlated with RV size [p<0.01 and p<0.05, respectively], while low E/A ratio and prolonged IRT were significantly correlated with PAP [p<0.05 and p<0.001, respectively]. No significant correlations were found between LV and RV dysfunctions or respiratory functional parameters. In conclusion, the prevalence of RV and LV dysfunctions is high in patients with ARF and LV dysfunction appears to be closely related to the RV size and the level of pulmonary hypertension

Applicable study for using the skin as a dialytic membrane in patients with chronic renal failure

Twenty patients with chronic renal failure [CRF] were subjected to immersion up to the neck in a bathing basin containing 200 liters of dialysate fluid at 37C for one hour. Serum urea and creatinine were evaluated before and after immersion; a significant decrease in serum urea[10.47%] and an insignificant decrease in serum creatinine [5.36%] were found after immersion. This simple type of dialysis can minimize the need for regular hemodialysis. Some points should be reevaluated to magnify the value of the resultant decrease in serum urea and creatinine; the volume of the dialysate fluid, the concentration gradient between patients serum and dialysate fluid and the temperature of the dialysate fluid and duration of immersion