Determinants of circulating soluble transferrin receptor level in chronic renal failure patiets

Anemia is a common problem in chronic renal failure [CRF] especially in patients under maintenance haemodialysis [HD] therapy. Soluble transferrin receptors [sTfR] is useful for quantitative assessment of erythropoiesis in HD patients but its specificity for detection of iron-defficient erythropoiesis in HD patients with recombinant human erythropoietin [rHuEpo] therapy is insufficient, even inconclusive and controversial. So the assessment of iron-deficient erythropoiesis is a hard task in HP patients during rHuEpo therapy. We designed this work aiming at identification of factors determining the sTfR level in CRF patients predialysis or on haemodialysis with and without rHuEpo therapy. Fifty CRF patients were studied who were divided into 3 groups:- Group I: 10 patients on conservative treatment.- Group II: 10 patients on regular HD but not on rHuEpo therapy.- Group III: 30 patients on regular HD and on rHuEpo therapy. We studied also two other groups, group IV: 10 anemic patients with normal kidney function and group V: 10 apperantly healthy control. We measured in all subjects sTfR level, s. Epo, transferrin saturation [TS%], s. ferritin, s. iron, TIBC, C-reactive protein, hypochrornic red cell percentage [HRC°/o] reticulocytic count and CBC. sTfR level was significantly raised in group III [dialysis with Epo] compared to group I [predialysis] [P < 0.01] and to group H [dialysis without Epo] [P < 0.0l]. sTfR was also significantly raised in group IV [anemic non uremic] compared to CRF groups [predialysis [P < 0.01], dialysis without Epo [P < 0.0l] and dialysis with Epo [P < 0.05]]. Haemodialysis patients with rHuEpo were stratified by less than 25. 25-75 and more than 75 percentiles of serum ferritin, by < 20 and > /= 20% of TS as well as by < 10 and > /= 10% of HRC%. The levels of sTfR in patients of lower quartile [mean +/- SD 4.9 +/- 1.5 micro g/l] was higher than those with upper quartile [mean +/- SD 2.23 +/- 0.78 micro g/l] and these with 25-75 percentile [mean +/- SD 2.48 +/- 0.69 micro g/l]. In CRF patients under dialysis with Epo there was significant positive correlation between sTfR versus basal Epo [P < 0.01], HRC% [P < 0.01], retics% [P < 0.01], Hct [P < 0.0l] and Hb [P < 0.01] but was significantly negative correlated versus TS [P < 0.01] and S.Ferritin [P < 0.01]. Multivariate regression analysis disclosed that HRC%, serum ferritin, Hct and TS% were the four independent predictors of sTfR levels and accounting for [68%] of the variability in sTfR. So, sTfR levels quantitatively reflects tile integrated effects of iron availability [HRC% and TS%], iron reserves [serum ferritin] and markers of erythropoiesis [Hct] and we conclude that sTfR levels is a good index of monitoring iron deficiency and erythropoietic activity in CRF especially those under HD therapy and receiving rHuEpo and it reflected the integrated effects of iron availability, iron reserves and erythropoietic stimulation

Antineutrophil cytoplasmic autoantibodies[ANCA] in active systemic lupus erythematosus

To test the presence of Antineutrophil cytoplasmic Autoantibodies [ANCA] in active SLE cases and its relationship to disease activity, 20 patients with active SLE [mean age=25 +/- 9.1 years] and 10 healthy controls [mean age=29 +/- 1.5 years] were studied. All were subjected to the following investigations: C.B.C, E.S.R, C.R.P., blood urea, serum creatinine, L.E, cell test, detection of DNA by agglutination method, cDNA and ANCA by indirect immunofluorescent technique. Four cases [20%] were found to have c-ANCA, one [5%] was found to have P-ANCA and 15 cases [75%] were negative to ANCA. A statistically significant decrease was found in ANCA-negative cases when compared with ANCA-positive cases as regard; renal function test, T.L.C., absolute neutrophil count, ESR and total score of the disease activity. It may be concluded that ANCA may have a significant value as a marker of SLE activity and may be of pathogenic significance in SLE cases