Insulin and glutamic acid decarboxylase antibodies in chronic hepatitis [C] patients with diabetes mellitus

Diabetes mellitus is associated more with HCV chronic liver disease than in the general population and in the other types of chronic liver disease. The increased incidence of diabetes in HCV patients might be related to an autoimmune process produced by the virus or the virus itself has a cytopathic effect on the pancreatic beta clells. The aim of this work was to study the plasma basal insulin level and the seropositivity against glutamic acid decarboxylase [GADA] - an islet cell cytoplasmic antigen. Patients: the study was carried out on 45 patients categorized into 3 equal groups. Group I included 15 diabetic patient with HCV chronic liver disease, Group II included 15 diabetic patients with chronic liver disease which is not related to HCV, Group III included 15 non diabetic patients with HCV chronic liver disease. All patients were selected to be matched regarding age, sex and sevirity of liver disease. The results showed that basal insulin level [22.4 +/- 23.1 micro IU/ml in group I, 21.6 +/- 23.8 micro IU/ml in group II, and 8.8 +/- 6.4 micro IU/ml in group III] were significantly higher in the diabetic patients [GI and GII] compared to the non diabetic [GIII] [P<0.01]. The insulin resistance index as calculated by HOMA equation [9.6 +/- 7.9 in group I, 9.2 +/- 10.3 in group II and 2.4 +/- 1.2 in group III], were also significantly higher in the diabetic groups [p < 0.01]. Seropositivity for [GADA] was 9/15 [60%] of patients of groups I and III and 3/15 [20%] of patients of group II. We concluded that diabetes mellitus associated with HCV chronic liver disease in characterized hyperinsulinaemia and increased insulin resistance. There may be a role of autoimmunity in the pathogenesis of diabetes in HCV chronic liver disease. Follow up of the non diabetic HCV patients with positive GADA for development of diabetes is recommended

Glomerular versus non-glomerular haematuria: detection by Coulter counter

Hematuria is a common diagnostic problem in clinical practice. Coulter counter offers an objective method for predicting the source of hematuria. In glomerular hematuria, red cell volume distribution curve [RCVDC] showed dysmorphic irregular distribution with RC volume smaller than 80 fl, while in non-glomerular hematuria RCVDC showed isomorphic regular distribution with RC volume larger than 80 fl. This study was carried out on 100 patients with hematuria, 50 patients diagnosed clinically as having glomerular hematuria and the others non-glomerular hematuria. In group 1, the mean RC volume was 64.49 +/- 11.81 fl, with dysmorphic RCVDC; while in group 2, the mean RC volume was 90.26 +/- 8.82 fl with isomorphic symmetrical RCVDC. The application of coulter counter in predicting the origin of hematuria showed sensitivity of 96% and specificity of 98%; while in non- glomerular hematuria, it showed sensitivity of 98% and specificity of 96%

Renal functional reserve in senescence

The effect of short-term protein loading on the glomerular filtration rate [GFR] [as represented by creatinine clearance [Ccr]] was evaluated in 20 subjects with age above 60 years [group 1 [GI]] and in 10 healthy young control with age from 20 to 30 years [group II [GII]]. By determining the Ccr preceding [baseline GFR] and following [test GFR] oral protein loading, it was possible to define [1] the filtration capacity [test GFR] and [2] the renal reserve [test GFR- baseline GFR] of the kidney. The increase in Ccr after protein load was statically significant in both groups [GI, GII]. The baseline and test Ccr of the elderly subjects were significantly lower than those of the young subjects [baseline Ccr was 87.5 +/- 60.2 ml/min/1.73 m2 in the elderly subjects and 1.45.7 +/- 79.8 ml/min/1.73 m2 in young subjects, stimulated Ccr was 115.3 +/- 69.5 ml/min/1.73 m2 in elderly subjects versus 172.3 +/- 75.7 ml/min/1.73 m2 in young subjects]. On the other h and renal reserve in both young and elderly subjects were similar [25.6 +/- 23.6 ml/min/1.73 m2 in young controls versus 27.8 +/- 24.5 ml/min/1.73 m2 in elderly subjects]. Renal functional reserve has a negative correlation to the amount of protein intake [as revealed by diet recall] and a positive correlation to test GFR in the elderly subjects