Impact of hyperuricemia on cardiovascular system in ESRD patients

Hyperuricemia was found to be associated with hypertension, coronary heart disease, metabolic syndrome and chronic kidney disease. However there are no specific data about the relationship of uric acid to cardiovascular disease and mortality in ESRD patients on chronic hemodialysis. So, we aimed to study the impact of hyperuricemia on cardiovascular system in chronic kidney disease and in ESRD patients on regular hemodialysis. This study included 100 patients in Ashmoun hospital, nephrology department. Patients were chosen and divided into two groups: Group A, 50cases with chronic kidney disease and Group B, 50cases of ESRD on regular hemodialysis. All cases were subjected to full clinical examination, measurement of eGFR, laboratory tests for blood urea, serum creatinine and serum uric acid and ECG. Serum uric acid was significantly higher in dialysis group than CKD group [p<0.01]. There was a highly significant correlation between uric acid and both systolic and diastolic blood pressure in Group A [all p values <0.01]. Also, there was a significant correlation between serum uric acid and eGFR [p<0.05].No significant difference found between Group A and group B as regards ECG findings [p>0.05]. In cases of CKD uric acid is involved in the pathogenesis of renal failure and hypertension. In patients with ESRD, hyperuricemia is not a risk factor for the development of cardiac disease; but it shows reversed epidemiology and becomes a marker of good nutritious status. Further studies should be done on wider scales to evaluate the impact of hyperuricemia on cardiovascular system in hemodialysis patients

Virulence factors of Streptococcus agalactiae in neonatal sepsis

Background: Streptococcus agalactiae or group B streptococcus [GBS] is a normal flora of the vagina of healthy women. It emerged as the leading cause of neonatal invasive infections

The purpose of this study was to detect the magnitude of GBS neonatal infection and colonization and to compare between invasive and colonizing strains as regard antibiotic susceptibility patterns, serotypes and virulence factors

Methods: A total of 145 neonatal blood samples and 95 vaginal swabs from pregnant women were collected in the present study. Invasive GBS were isolated from neonates by blood cultures. Colonizing GBS isolates were identified by vaginal swabbing of pregnant women using Todd-Hewitt selective broth medium, supplemented with gentamicin [8microg/mL] and nalidixic acid [15microg/mL]. Antibiotic sensitivities and serotyping by latex agglutination were done. GBS virulence factors were studied including detection of beta-haemolysin production, CAMP test on blood agar plates, C5a peptidase production encoded by scpB gene and presence of highly virulent GBS ST-17 clone

Results: GBS were isolated from 11.7% of neonates [17/145] and from 18.9% [18/95] of vaginal swabs. Resistance patterns of isolated invasive GBS were 29.4 %, and 17.6% for erythromycin and clindamycin respectively. Among invasive and colonizing GBS isolates, serotype III was the most common. GBS neonatal sepsis was significantly associated with respiratory distress, pneumonia, use of mechanical ventilation and use of nasal continuous positive airway pressure. All of GBS isolates were CAMP test positive. Hemolytic GBS were 91.4% [32/35] of isolates. The scpB gene was detected in 88.2% and 88.9% of invasive and colonizing GBS isolates respectively while presence of ST-17 clone was significantly associated with invasive GBS isolates with P value of 0.002

Continuous renal replacement therapies in ICU patients with septic shock: impact on inflammatory mediators removal

Continuous renal replacement therapies are widely used for patients with acute renal failure specially in critically ill patients in ICU. It has been suggested that hemofiltration may also eliminate toxic mediators thought to be important in the pathophysiology of sepsis. The present study examined whether hemofiltration can eliminate inflammatory mediators in patients with sepsis. A total of 28 consecutive patients with septic shock, as defined by the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. All patients had renal affection. Patients were randomly assigned to receive hemofiltration in addition to usual ICU care [n = 17] [group 1], or to usual care plus hemodiafiltration [n =11 [group 2]. We measured the plasma concentrations of complement fraction C3a, IL-6 and TNF -a at baseline, 2 hours and 24 hours after these procedures. C3a showed a fall in concentration between baseline and 2 hrs, which not reached statistical significance during hemofiltration [from median 495.5 to 363 ng/ml, P =.48] and statistical significance during hemodiafiltration [from median 524 to 379.7 ng/ml, P = <0.05]. Furthermore, during HF C3a showed a significant fall in concentration during the interval between 2 hrs and 24hrs [from median, 363 to 274.6 ng/mL, p<0.05], HDF [from median, 379.7 to 215.8 ng/mL, p<0.05]. TNF showed a fall in concentration between baseline and 2 hrs, which reached statistical significance during hemofiltration [from median 397.9 to 332.8 pg/ml, P =0.035] and statistical significance during hemodiaflltration [from median 430.7 to 347.2 pg/ml, P 0.02]. However, during HF TNF showed a non significant change in concentration during the interval between baseline and 24hrs [from median, 397.9 to 410.4 pg/mL, p = 0.6], HDF [from median, 430.7 to 405.6 pg/mL, p = 0.5]. IL-6 showed a fall in concentration between baseline and 2 hrs, which reached statistical significance during hemofiltratio in [from median 1051 to 843.6 pg/ml, P =0.03] and statistical significant during hemodiaflltration [from median 1111.3 to 859 pg/ml, P 0.025]. However, during HFJL-6 showed a non significant change in concentration during the interval between baseline and 24hrs [from median, 1051 to 905 pg/ml, p = 0.13], HDF [from median, 1111.3 to 901.9pg/mL, p = 0.07]. No correlation were detected between inflammatory mediators removal and changing the size of hemofilter [surface area 0.7 and 1.35 square meter] p>0.05. or changing hemofiltration rate [from 1 to 2 liters/hour]. p>0.05. In conclusion, short-term hemofiltration with a highly biocompatible membrane in patients with septic multiple organ dysfunction syndrome and renal failure may even eliminate some of the mediators from septic plasma like C 3a. Filtration of the classic cytokines IL-6 and TNF-a is presumably of minor importance, but clearance of the first few hours may occur so we cannot advocate the use of continuous therapies as a treatment in sepsis for removal of inflammatory mediators only, but in presence of renal affection, these slow renal replacement therapies results in fewer cardiovascular side effects than intermittent techniques, Furthermore, continuous hemofiltration allows better control of fluid balance and simultaneous continuation of total parenteral nutrition in addition to reduction of anaphylatoxin concentrations which could be of clinical importance, since beneficial therapeutic effects in sepsis have been correlated with a fall of anaphylatoxin concentrations

Thrombopoietic status of Egyptian patients with ESRD on different forms of renal replacement therapies

Thrombocytopenia is a frequent problem of ESRD patients. The factors affect platelet counts are unknown completely. Thrombocytopenia was most frequent in the HCV positive hemodialysis patients. The effect of HCV anti-genaemia on thrombocytopenia was not clarified. This study included 220 patients with ESRD treated by HD [150 patient, 81 M and 69 F], Renal transplantation [50 patient, 27 M and 23 F] and CAPD [20 patient, 9 M ana 11 F] as well a 50 patient with HCV infection but without renal affection and 50 healthy control matched for age and sex with the cases. They were divided into six groups. All patients and controls were subjected to full medical history and clinical examination, CBC, kidney function tests, liver function tests, HCV antibodies and abdominal ultrasonography. Hemodialysis group is subjected to other investigations [HCV RNA by PCR as well as PTH, Kt/V and Measurement of platelet-associated immunoglobulin PAIgG [for thrombocytopenic patients] was determined by a competitive micro-RLISA method]. The results of this study showed significant presence of thrombocytopenia among patients on different RRT and the HCV positive patients who don't undergone dialysis and among the HCV negative patients with CRF on regular hemodialysis. The results showed also significant presence and higher incidence of thrombocytopenia among HCV positive patients with CRF on regular HD as compared to other groups. We also found that thrombocytopenia significantly increases with increased duration of dialysis and with cellulose type of hemodialysis membranes and Platelet counts had no significant relation with any of the drugs prescribed or with serum creatinine, urea nitrogen, iPTH, or Kt/V. HCV - positive hemodialysis patients had a higher incidences and a higher PAIgG liters than HCV-negative hemodialysis patients. The present study showed that thrombocytopenia was found in CRF patients on different renal replacement therapies especially in HD patients and more evident among those with +ve HCV antigenaemia. Even more than non uremic patients with +ve HCV antigenaemia. Follow-up of platelet count may be beneficial in HD patients for early detection and treatment of thrombocytopenia in these patients

Impact of hepatitis viruses B and C on the management of anemia in CRF patients on regular haemodialysis

Anemia remains virtually the most common complication in chronic renal failure patients. Iron deficiency has emerged as the major factor that limite of response to recombinant human erythropoietin [rHuEPO], and treatment by intravenous iron has been advocated to treat iron deficiency. Hepatitis viruses [particularly HCV] is prevalent in dialysis patients and is common in Egyptian dialysis patients, and its effect on iron parameters and anemia is not well studied. Is to study the impact of hepatitis viruses B and C on management of anemia in HD patients and to study the iron status, target hemoglobin and the clinical improvement on two regimens of therapy, iron alone and iron and rHuEPO. Sixty patients with CRF on regular haemodialysis were studied. The patients were divided into three main groups: Group [A]; 18 patients with positive HbsAg, Group [B]; 22 patients with positive anti-HCV antibody and group [C]; 20 patients with negative HbsAg and negative anti HCV antibody. Half of the patients in each group [groups A [I], B [I], and C [I]] were given intravenous iron [regimen I] only and the second half [groups A [II], B [II], and C [II]] were given intravenous iron and rHuEPO [regimen II]. All patients had been subjected to; full medical history and clinical examination, Kamofsky's score [KS], hemoglobin, hematocrit, blood indices, iron status; Serum ferritin and transferrin saturation, hepatitis markers; HbsAg and anti-HCV antibody. For patients on regimen I [who were given intravenous iron only], we found a significant increase [p < 0.01] of the mean hemoglobin which represents 18.8% of the baseline value. Patients on regimen II [who were given intravenous iron and subcutaneous rHuEPO], showed highly significant increase [p < 0.0001] of hemoglobin [32.9% of the baseline value]. In groups A and B [HbsAg positive and anti-HCV positive patients], we found significant increase [p < 0.01] in mean hemoglobin reaching to 22.893% of the baseline value. However, this response is significantly lower [p < 0.03] than the hemoglobin response in anti-HCV negative patients, who showed increase of 31.045% of their basal HB in both regimens of treatment. Baseline serum aminotransferases [ALT, and AST] were significantly higher [p < 0.05] in hepatitis-positive than in negative patients, and positive correlation between baseline SF and aminotransferases was noted. However, there was no significant rise [p = 0.08] of aminotransferases after iron and erythropoietin therapy. The study revealed accepted efficiency of both SF and TSAT tests in all groups [83.3% for SF and 93.3% for TSAT] with high sensitivity [86.3 for SF and 96.1% for TSAT], average specificity [77.8% for SF and 66.7% for TSAT] and high predictive values for positive responses [93.6% for SF and 89.1% for TSAT] in all groups. There was positive correlation between final HB achieved and KS scores of the patients. Iron status is a mandatory investigation for all anemic CRF patients on regular HD. In HbsAg positive or anti-HCV positive dialysis patients: There were significant response to intravenous iron alone in iron deficient patients and the response is highly significant with intravenous iron and rHuEPO; however this response is significantly lower than that observed in virology negative patients. There were non significant rise of aminotransferases. Both serum ferritin and transferrin saturation are simple, safe, and have accepted sensitivity, specificity, and efficiency for diagnosis of iron deficiency in haemodialysis patients including hepatitis virus positive patients. Administration of intravenous iron did not result in increase in liver enzymes in either group. Quality of life is significantly improved in all groups due to improvement of anemia