Prevalence of access recirculation in prevalent arterio-venous [A-V] fistula hemodialysis patients and its effect on hemodialysis adequacy

Background: Assessment of access recirculation [AR] is crucial to dialysis efficiency and there is thus a need for a method yielding a highly accurate, fast, easy and economical measurement that can be applied in any dialysis clinic. Non-urea based dilutional methods are more accurate than urea based methods and avoid problems with cardiopulmonary recirculation, but they require expensive specialized devices, which limit their applicability

Patients and Methods: We used simple dilutional method of AR based on the determination of serum potassium [K+] in two samples. A prospective study was performed in a Dialysis Unit at El Sahel Teaching hospital, Cairo, on End stage kidney disease patients on regular Hemodialysis through a functioning Arterio-venous fistula

Results: Access recirculation was found in 42% of studied patients. There were Highly Significant positive correlation between access recirculation, pre / post dialysis blood urea, basal k, and parathyroid hormone level. In addition, there were highly significant negative correlation between AR, Urea reduction ratio and KT/V

Conclusion and Recommendations: Potassium dilution method is one of the most simple, specific, and economical way to measure access recirculation and can easily be performed in any dialysis unit. We recommend more research should be done about hemodialysis adequacy, access recirculation and how to improve it

Homocysteine level in renal transplant recipients and its correlation to glomerular filtration rate, cyclosporine level and folate level

Cardiovascular disease [CVD] is the most common cause of death after renal transplantation [RT]. Hyperhomocysteinemia is identified as a risk factor for CVD. RT recipients [RTRs] have an excess prevalence of hyperhomocysteinemia. The objectives of this study were to determine homocysteine [tHCY] level in stable RTRs and correlate its level to graft function, cyslosporine level and folate level. Twenty RTRs of 1[st] living renal allografts, 16 males and 4 females with a mean age of 44.1 +/- 5.1 years and a transplant duration of 22.2 +/- 12.6 months were included in this study. Their mean serum creatinine, blood urea and GFR were 1.5 +/- 0.6 mg/dL, 63 +/- 27.7 mg/dL and 53.9 +/- 32.8 ml/ min respectively. Hyperhomocysteinemia was recorded in all RTRs, mild in 13 [65%] and moderate in 7 [35%] with a mean of 27.9 +/- 12.8 umol/L. Plasma folate level was low [4.5 +/- 5.5 ng/mL]. A significant positive correlation was recorded between tHCY level and both blood urea and serum creatinine [r 0.529, 0.279 respectively, P < 0.05]. There was a significant negative correlation between tHCY level and both GFR and plasma folate level [r - 0.375, - 0.416 respectively, P < 0.05]. No correlation between tHCY level and both duration of renal transplantation and cyclosporine level was recorded. In conclusion, inadequate folate level and or failure to restore normal renal function may be relevant to hyperhomocysteinemia observed in RTRs. tHCY level lowering can be achieved safely, rapidly and in-expensively with B-vitamin intervention

Autoantibodies in HCV infected patients at Sharkia Governerate, Egypt

The aim of this study was to evaluate some immunological manifestations in chronic hepatitis C patients and to find out its relationship with liver pathology. The study included 109 positive HCV-RNA patients classified according to liver histopathology into three groups: Group I included 22 patients [G1S1], group II included 67 patients [G2S2] and group III included 20 patients [G3S3], where G = the degree of necro-inflammatory process and S = the stage of liver fibrosis. All patients were investigated for the presence of cryoglobulin, antineutrophil cytoplasmic [ANCA], anti-liver kidney microsomes [LKM], anti-double stranded DNA, [ds-DNA], anti-nuclear [ANA], anti-mitochondrial [AMA] and anti-smooth muscle [ASMA] autoantibodies. The high prevalence of autoantibodies in chronic HCV patients suggests that HCV may trigger an autoimmune reaction, but most probably do not indicate a distinct autoimmune mechanism. Cryoglobulins and ANCA may be considered as useful prognostic indicator for the increased risk of cirrhosis in chronic HCV patients. Follow up studies were recommended

HCV and associated concomitant infections at Sharkia Governorate Egypt

This study was performed on 109 cases divided into 6 groups according to the concomitant infection with hepatitis C virus [HCV]. The results proved that groups 1, 3 and 5 had a higher level of viremia than the other groups and a higher risk was found in these groups, as 56.4% and 34.6% were in G2S2 and G3S3, respectively. All cases of liver cell dysplasia and hepatocellular carcinoma in this study were seen in these groups. The study concluded that these factors play an important role in the progression of HCV infection. The death of the patients of this progressive condition occurs in younger age and due to liver failure more than to HCC

Non-invasive markers and predictors of severity of hepatic fibrosis in HCV patients at Sharkia Governorate, Egypt

This study included 109 patients with detectable hepatitis C virus [HCV] by real time PCR. The patients were classified into three different pathological stages and grades according to the new concept of histopathological staging and grading. The different clinical, biochemical, virological and ultrasonographic parameters were assessed and analyzed and the variables that showed a significant association with the histopathological staging and grading were included in the multivariate logistic regression analysis. The regression model revealed that platelet count, matrix metalloproteinase-9 [MMP-9], portal vein diameter, splenic longitudinal axis, alanine transaminase, aspartate transaminase and viral load added a significance to the model in a decreasing order of significance. From these findings, a new score ranged from 0-9 was generated. The score model was applied to the patients to assess its validity, where it proved to be accurate in discriminating patients with mild inflammation and fibrosis [sensitivity 81.8%, specificity 80.5% and accuracy 80.7%] and more accurate in detecting patients with cirrhosis [specificity 96.6%, sensitivity 80% and accuracy 93.6%], but less accurate in detecting patients with moderate to severe fibrosis [specificity 66.7%, sensitivity 68.7% and accuracy 67.9%]. Also, the results revealed that co-infection with schistosomiasis, old age >/45 years and positive history of blood transfusion as a source of infection were significantly associated with severe hepatic pathology

Lipoprotein [A] in nephrotic syndrome

Lipoprotein [a] [Lp [a]] is an independent risk factor of early atherosclerosis with atherogenic and thrombogenic properties. Several studies have described a correlation between high plasma Lp [a] level and coronary heart disease, stroke and peripheral atherosclerosis. We measured plasma Lp [a] concentration in 21 patients with primary untreated nephrotic syndrome. Lp [a] levels were determined by immunopreciptin analysis. Data were compared with a healthy control group matched for age and sex. Histological lesions were MCGN in 1 pateint, MPGN in 4 patients, membranoproliferative GN in 8 cases, memberanous GN in 4 cases, focal segmental glomerulosclerosis in 3 patients and crescntic GN in 1 patient. 57% of nephrotic patients had Lp [a] levels > 30 mg /dl compared to 20% in the control group. There was no significant difference in Lp [a] levels with respect to the underlying renal pathology, there was no significant correlation between Lp [a] and urinary protein excretion, renal functions, or with other lipid parameters including total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol. There was however a significant inverse correlation between Lp [a] and serum albumin [r = - 0. 464, p = 0.034]. Our findings suggest that decrease in serum albumin led to increased hepatic Lp [a] synthesis