Comparison of glycosylated hemoglobin and serum fructosamine as an index of glycemic control in diabetic patients with chronic renal failure

This study aimed to compare between glycosylated hemoglobin HbA[IC] and fructosamine in diabetic patients with C.R.F. to determine which of them is more valid as an index for glycemic control. Our work was carried on five groups each consisted of twenty diabetic non-uremic [group I], diabetic uremic on regular hemodialysis [group II] diabetic uremic on conservative treatment [group III], uremic non diabetic on regular hemodialysis [group IV] and healthy control subjects [group Y]. All of them were investigated for total plasma protein, fasting and post prandial serum gluose, serum creatinine, hemoglobin content, HbA[IC] and serum fructosamine level. It was evident from his work that the level of both HbA[IC] and fructosamine was significantly higher in diabetic patients with and without uremia when compared to control group. Although HbA[IC] level was significantly low in uremic non-diabetic patients, serum fructosamine level didn't change significantly in these patients. This finding can be explained by the fact that the life span is shortened in uremic patients, while both parameters which affect serum fructosamine level [blood sugar and total protein] showed no significant alteration in these patients. A negative non-significant correlation was found between seum creanine and both HbA[IC] level and serum fuctosamine level among all studied. In all studied groups, plasma glucose [Fasting and post prandial] showed positive significant correlation with both glycosylated hemoglobin and serum fructosamine. HbA[IC] correlated significantly with Hb level, mean while serum fructosamine correlated significantly with total serum protein. We can conclude that serum fructosamine is the test of choice for judging the glycemic control in uremic patients, because it is not affected by uremia and because of its automaticity, reproducibility and cheapness

Study of T-cell count in uremic patients with HBs antigenemia

This work was carried out on 10 healthy volunteers who served as a control group [Gl]. and 50 patients with chronic renal failure. The uremic patients were divided into 5 groups, each consisted of 10 patients. Group 2 [G2] comprised patients with negative HBsAg. Group 3 [G3] comprised patients treated with conservative measures who are chronic healthy carrier for HBsAg. Group 4 [G4] comprised patients treated with conservative measures who suffered from chronic active hepatitis due to HBV infection. Group 5 [G5] comprised dialyzed patients who are chronic healthy carrier for HBsAg. Group 6 [G6] comprised dialyzed patients who suffered from chronic active hepatitis due to HBV infection. The following laboratory investigations were performed to all subjects: complete blood picture, counting of T-lymphocytes, HBsAg, blood urea, serum creatinine, serum bilirubin and serum transaminases. Diagnosis of chronic active hepatitis was confirmed by liver biopsy. Our study showed that chronic renal failure as well as haemodialysis decreased significantly both total lymphocytic count and absolute T-cell count. Total lymphocytic count and absolute T-cell count showed significant negative correlation with blood urea, serum creatinine, duration of dialysis, and the age of patients. HBsAg positive uremic patients showed siginificant reduction in absolute T-cell count, but didn't show significant change in total lymphocytic count, when compared with HBsAg negative uremlc patients. No significant difference could be found in both total lymphocytic and absolute T-cell count between chronic active hepatitis uremic patients and chronic healthy carrier uremic patients. Finally, no significant correlation was detected between the biochemical parameters of liver function [total serum bilirubin, SGOT and SGPT] and both total lymphocytic count and absolute T-cell count