Nosocomial infections and fever of unknown origin in pediatric hematology/oncology unit: a retrospective annual study

Pediatric hematology / oncology patients are faced with an increased risk of nosocomial infections [NIs] that vary in different populations and different institutes with considerable morbidity and mortality. Our aims were to assess the frequency and patterns of NIs in this group of patients relation to the risk of neutropenia and to determine the prevalence of causative organisms and their antimicrobial sensitivities. A retrospective analysis of the data for all children admitted to pediatric hematoloy/oncology unit of Mansoura University, Egypt, was done over one year from January, 2007 to January, 2008. A total of 1564 patients were included [173 children with leukemia, 39 with lymphoma, 49 with other solid tumors, 1293 with thalassemia and 10 withaplastic anemia] corresponding to 2084 admissions and 27092 inpatient days. The Centers for Disease Control and Prevention criteria were used as standard definition for NI. The overall incidence density rates of NIs in all patients and neutropenic patients were 8.6 and 25.3 per 1000 patient-days respectively. The most frequent sites of microbiologically and or clinically documented NIs were blood stream [42.7%], respiratory [25.3%], Urinary [22.2%] and CNS infections [9.8%] whereas nosocomial fever of unknown origin [nFUO] constituted 52.9% of defined cases with incidence density rates of 9.7 and 15.4 per 1000 patient-days in, all patients and neutropenic patients respectively. The frequency of NIs and nFUO were significantly higher during neutropenic days [p<0.001]. Gram-positive organisms represented 64.5% of isolated pathogens [Staphylococci 71.5%, Streptococci 16%, Pneamococci 7% and Enterococci 5.5%], gram-negative organisms represented 30% [E coli 48.6%, Klebsiella 15.7%, and Pseudomonas 35.7%], and Candida 5.5%. Positive cultures were more frequent in summer months [July to September]. The antimicrobial susceptibilities of the isolated organisms were relatively low [cefoperazone/sulbactam 49.9%, amikacin 35.9%, imipenem/cilastatin 34.4%, cefoperazone 33.6% and vancomycin 36.5%]. Blood stream infection and fever of unknown origin are the most common nosocomial infections in pediatric hematology / oncology patients with a higher risk during neutropenic days. Isolated organisms are multi-drug resistant, predominantly gram-positive pathogens

Urinary abnormalities in asymptomatic primary school Egyptian children

To detect the prevalence of asymptomatic urinary abnormalities in primary school Egyptian children, 1670 healthy children from Dakahila governorate were screed for hematuria and proteinuria using dipstick method. They were 910 males and 760 females. At the first screening, 22 children [1.3%] had urinary abnormalities however only 12 [0.72%] out of them had urinary abnormalities at the second screening. Out of children who had urinary abnormalities, six [0.36%] had isolated hematuria [IH], two [0.12%] had isolated proteinuria [IP] and four [0.24%] had combined hematuria and proteinuria [CHP], Renal biopsy was performed on four children [two had CHP, one had IH and the other had IP]. PSAGN was identified in three children of those who had lH. While the other two had hypercalciuria and renal stone and no abnormality was detected in the sixth child. One of IP children had orthostatic proteinuria while the other had focal segmental glomerulosclerosus. The pattem of renal diseases in CHP children was PSAGN in two, diffuse mesangial proliferation in one and IgA nephropathy in the other. In conclusion, asymptomatic urinary abnormalities are not present in considerable percentage among primary school children in our locality. PSAGN is the leading cause for these abnormalities. Only three children have evidence of chronic kidney disease which raises the issue of considering the cost-benefit ratio before the national implementation of the urine screening program

Serum angiogenin level in congenital heart diseases

Abnormal angiogenesis is reported in patients with con-heart diseases [CHD]. Angiogenic growth factors play an important role in the regulation of angiogenesis. This study was done to assess angiogenin [ANG] levels in children with CHD, its correlation with degree of hypoxaemia and its relation to the development of pulmonary hypertension [PH]. Serum ANG level was assessed by sandwich .enzyme immunoassay technique in 36 children with cyanotic congenital, heart diseases [CCHD] and in 35 children with acyanotic congenital heart diseases [ACHD]. Both groups were compared to 12 healthy controls of matched age and sex. CCHD patients had higher serum ANG levels compared to ACHD [177.8 +/- 53.7 Vs 149.4 . +/- 51.2 ng/ml, P=0.02] and controls m8 +/- 53.7 Vs 114.8 +/- 51.8 ng/ml, P 0.002]. A1VG was negatively correlated with pO2 and O2 saturation [r =-0.46, p=0.004 and r =-0.403, p 0.015; respectively]. AATG level in ACHD was not significantly different from controls [149.4 +/- 51.2 Vs 114.8 +/- 51.8 ng/ml, P=0.06]. In ACHD, patients with PH had significantly elevated ANG levels when compared to without PH [188.9 +/- 48,7 Vs 137.7 . +/- 46.6 ng/ml, P=0.011 and to controls [1 88.9 +/- 48.7 V 114.8 +/- 51.8 ng/ml, P=0.005]. Increased ANG in CCHD-secondary to hypoxemia-may responsible for abnormal angiogenesis in these patients. Increased ANG levels in ACHD patients with PH may be a compensatory mechanism aiming for neovasculrization distal to the site of pulmonary vascular obstruction

Fas and BCL-2 oncoprotein as an apoptotic markers in HCV- positive blood donors

To study the factor of apoptotic signal [FAS] amid B-cell leukemia lymphoma [BCL-2] oncoprotein as markers of apoptosis in blood donors. The study included 121 voluntary blood donors attending the Blood Bank of El-Minia University Hospital. They were divided into three groups according to HCV antibodies and qualitative HCV-RNA PCR: Group I: HCV antibodies and RNA- PCR negative [n =40], Group II: HCV antibodies positive and- RNA- PCR positive without liver cirrhosis [n=70] and Group III: HCV antibodies positive and- RNA- PCR positive with liver cirrhosis [n=11]. Each subject was submitted for the following investigations: Complete blood count, liver function tests, alpha fetoprotein assay by ELISA method, FAS [CD95] antigen, and intracellular BCL-2 oncoprotein on lymphocytes by flow cytometry. FAS is significantly higher in group II and group III when compared with that in group I [P=0.0 for both]. On comparing group III with group II, also FAS is significantly higher in group III [P=0.021]. Significant positive correlation between FAS and both ALT, AST, and AFP was found [r =0.39, 0.47and 0.39 respectively and P = 0.0 for all] while there was significant negative correlation between FAS and both platelets and albumin [r= -0.52 and -0.46 respectively and P = 0.0 for both] in the total diseased group [group II + III]. BCL-2 is significantly higher in group II and group Ill when compared with that in group I [P=0.001 and 0.0 respectively]. On comparing group Ill with group II, also BCL-2 is significantly higher in group III [P= 0.0]. Significant positive correlation was found between BCL-2 and ALT, AST, and AFP [r= 0.29, 0.39and 0.41 respectively and P= 0.0 for all], while there was a significant negative correlation between BCL-2 and both platelets and albumin in the total diseased group [r= -0.53 and -0.41 respectively and P= 0.0 for both]. A significant positive correlation was found between FAS and BCL-2 in the diseased group [r=0.321 and p=0.007]. FAS and BCL-2 as an apoptotic markers play an important role in the pathogenesis and further outcome of chronic liver diseases

Diurnal pattern of plasma endothelin-1: effect on endothelium-dependent vasodilatation in patients with stable angina pectoris

This study included two groups of patients: Group I included 20 patients with stable angina pectoris [SA] [18 men and 2 women, aged 50.51 +/- 8.29 years] and group II included 20 healthy subjects [17 males and 3 females, aged 48.11 +/- 6.31 years] taken as a control group. Flow-mediated vasodilatation [FMD] of the brachial artery [a surrogate for endothelium-dependent vasodilatation] was determined by ultrasound at 8 a.m. and 8 p.m. Also, carotid artery intima-media thickness [IMT] was determined by ultrasound. The plasma levels of C- reactive protein [CRP] and ET-1 were determined at 8 a.m. and 8 p.m. The study included that the normal subjects had diurnal variation in endothelium-dependent vasodilatation that may counteract other, potentially adverse, diurnal variations in the hemodynamic and other parameters. In contrast, patients with SA showed a loss of this protective mechanism. No diurnal variation in plasma CRP was found to explain this finding. Diurnal variation in plasma ET-1 levels is likely one of the mechanisms involved in the pathogenesis of this phenomenon

Serum testosterone and carotid atherosclerosis in men with type 2 diabetes: is there a link?

This study included 50 male patients with type 2 diabetes aged 56.2 +/- 7.8 years, with a body mass index [BMI] of 28.3 +/- 2.6 kg/m 2, a duration of diabetes 10.6 +/- 6.4 years; in addition, 25 age- matched lean healthy subjects were taken as a control group. Body mass index [BMI], waist to hip ratio [WHR], plasma lipids, homeostasis model assessment of insulin resistance [HOMA-IR], plasminogen activator inhibitor-1 antigen [PAI-1 Ag] and plasma total testosterone [T] were assessed. Carotid intima-media thickness [IMT] and plaque score [PS] were evaluated by ultrasound. The study concluded that total serum testosterone is inversely associated with carotid atherosclerosis determined by ultrasonographically evaluated carotid IMT and PS in men with type 2 diabetes. Low serum testosterone is associated with an adverse cardiovascular risk profile in these patients

Plasma soluble tumor necrosis factor alpha receptor 2 in obese subjects with impaired glucose tolerance

A total of 55 subjects participated in this study; 20 obese subjects with normal glucose tolerance [NGT], 20 obese subjects with impaired glucose tolerance [IGT] and 15 lean healthy control subjects with NGT. Body mass index [BMI], waist to hip ratio [WHR], plasma lipids and homeostasis model assessment of insulin resistance [HOMA-IR] were assessed. Plasma tumor necrosis factor-alpha [TNF-alpha] and soluble tumor necrosis factor receptor 2 [sTNFR2] were assessed by enzyme- linked immunosorbent assay [ELISA]. The study concluded that obese IGT subjects are more insulin resistant compared with the matched obese NGT subjects. The further increase in insulin resistance in IGT group is not due to the increase in plasma TNF-alpha and may be due to up-regulation of TNF-alpha system manifested by the increased plasma sTNFR2 levels. Therefore, sTNFR2 might be a better marker of TNF- alpha action in insulin-resistant states such as obese IGT subjects than the circulating cytokine itself

Plasma soluble tumor necrosis factor-alpha recepector 2 in lean normoglycemic subjects with a strong family history of type 2 diabetes

Twenty lean normoglycemic subjects with strong family history of type 2 diabetes [aged 38.2 +/- 8.61 years, with BMI 22.35 +/- 1.57 kg/m 2] and 15 age, sex and BMI matched subjects with no family history of type 2 diabetes [control group] were included in this study. Fasting plasma glucose [FPG], oral glucose tolerance test, fasting plasma insulin [FPI], homeostasis model assessment for insulin resistance [HOMA-IR], plasma lipids, plasma TNF-alpha and soluble tumor necrosis factor alpha receptor 2 [sTNFR2] were assessed. The study concluded that lean subjects with strong family history of type 2 diabetes are insulin resistant. The insulin resistance in this group is not due to an increase in plasma TNF-alpha and may be due to the up-regulation of TNF-alpha system manifested by the increased plasma sTNFR2 levels. Therefore, sTNFR2 is a better marker of TNF- alpha action in these subjects than the circulating cytokine itself

Proinflammatory cytokines and endothelial dysfunction in obese subjects: effect of weight reduction

Obesity is associated with an increased risk of developing atherosclerosis, which may be mediated, at least in part, by increased secretion of proinflammatory cytokines by adipose tissue. The aim of present study was to determine whether circulating levels of inflammatory cytokines and intercellular adhesion molecule-1 [sICAM-1] are elevated in obese subjects and whether they could be reduced by a substantical decrease in body weight. Forty-two healthy obese subjects [22 females and 20 males, age range 25 to 40 years, body mass index 35.2 +/- 3.64 Kg/m2, waist to hip ratio 0.883+0.085, and 20 age and sex matched normal weight controls were studied. Compared with nonobese subjects, obese subjects had increased basal concentrations of tumor necrosis factor-alpha [TNF-alpha]. [P<0.001], interleukin-6 [IL-6], [P<0.001] and sICAM-1 [P<0.001]. Flow mediated dilatation [FMD] was impaired in obese subjects when compared to lean controls [7.52% +/- 3.05 Vs 10.28% +/- 1.64, P<0.001]. Concentrations of TNF-alpha and lL-6 were related [P<0.001] to visceral obesity, as well as to slCAM-1 levels and FMD. After one year of a multidisciplinary program of weight reduction [diet, exercise, behavioral counseling], all obese women lost at least 10% of their original weight. Compared with baseline, sustained weight loss was associated with reduction of cytokines [TNF-alpha, IL-6] [P<0.001] and sICAM-1 [P = 0.001] concentrations in addition to improvement of FMD [P<0.001]. In obese subjects, endothelial activation and dysfunction correlates with visceral body fat, possibly through inappropriate secretion of cytokines. Weight loss represents a safe method for downregulating the inflammatory state and ameliorating endothelial dysfunction in obese subjects

Relationship between plasma homocysteine level and some cardiovascular risk factors in patients with type 2 diabetes

High plasma homocysteine [Hcy] concentration is risk factor for cardiovascular disease. Insulin resistance has been hypothesized to play an important role in the development of atherosclerotic disease. The information on the association between insulin resistance, other cardiovascular risk factors and plasma Hcy in type 2 diabetes is limited. The aim of our study was to assess the impact of insulin resistance and other cardiovascular risk factors on plasma total Hcy levels in patients with type 2 diabetes. The study included 40 patients with type 2 diabetes [aged 42.0 +/- 4.1 years] and 15 healthy controls, matched in age and sex with the patients. The following parameters were assessed: fasting plasma glucose [FPG], fasting plasma insulin [FPI], homeostasis model assessment of insulin resistance [HOMA-IR], serum total cholesterol, triglycerides, HDL-C, LDL-C and plasma total Hcy. Our study revealed significant increase in SBP, FPG, FPI, HOMA-IR, and total Hcy in type 2 diabetic patients compared to control group [137 +/- 4 vs 123 +/- 5 mmHg, 103 +/- 10.1 vs 83.2 +/- 6.9 mg/dl; 20.1 +/- 4.1 vs 8.8 +/- 3.1 mu/L, 5.8 +/- 0.8 vs 1.93 +/- 0.26, 13.6 +/- 1.2 vs 7.6 +/- 0.8 umol/L, respectively, all P<0.001]. As regard serum lipids our results revealed significant increase in total cholesterol, triglycerides and LDL-C but significant decrease in HDL-C in type 2 diabetic patients compared to control group [210 +/- 39 vs 160 +/- 21 mg/dl, 220 +/- 29 vs 106 +/- 10 mg/dl, 129 +/- 28 vs 88 +/- 21 mg/dl, 40 +/- 11 vs 52 +/- 16 mg/dl, respectively, all P<0.05]. In patients with type 2 diabetes there was significant positive correlation between total Hcy and SBP, FPG, FPI, HOMA-IR, total cholesterol and LDL-C [r = 327, P = 0.005, r = 240, P = 0.049, r = 0.513, P<0.001; r = 0.601, P<0.001, r = 0.241, P = 0.048; r = 0.250, P = 0.040 respectively], but there was significant negative correlation between total Hcy and HDL-C [r = -0.301, P = 0.009]. Increases in total homocysteine levels in type 2 diabetes are associated with insulin resistance and other cardiovascular riskfactors. Thus insulin resistance may be an important determinant of Hcy levels in those patients

Soluble transferrin receptor: a possible index of body iron status

Erythrocyte microcytosis and hypochromia constitute a haematological problem associating many haematological disorders such as true iron deficiency anemia and anemia complicating chronic diseases. Therefore, the present study has been planned for evaluating the level of soluble transferrin receptor [sTfR] as a differentiating parameter in these conditions. The study included 40 patients with hypochromic microcytic anemia who were classified as a true iron deficiency [IDA] group and a group of anemia of chronic disease [ACD], in addition to a control group of matched age and sex. Serum TfR and conventional iron parameters were evaluated in all included individuals. Soluble TfR was found to be significantly higher in patients with IDA, while in ACD patients, its level showed a non-significant change. Moreover, TfR/Log ferritin ratio [TfR-F index], was shown to be significantly elevated in IDA than either ACD or healthy controls. This ratio was also found to be more convenient, than serum ferntin, in differentiating ACD from that of iron deficiency. In addition, a nonsignificant difference was observed among both anemic groups as regards other parameters of iron status. On the other hand, sTfR was significantly inversely correlated with serum iron, serum ferritin and Hb in both anemic groups. It could be concluded that sTfR may be considered as a possible important parameter for evaluation of body iron status and in differentiation of the true iron deficiency anemia from that of chronic disease

Erythropoietic response to androgen replacement therapy Erythropoietic and role of IL-6 in aging male rats

Changes in iron status and bone marrow Junctions are frequently observed in the elderly. These phenomena are often associated with chronic diseases and/or neoplcfsmas. In a minority of elderly subjects; it is not possible to identify the causes of anemia. This study was carried out to clarify the functional capacity of the erthropoietic tissues of the aged rats, to investigate the role of IL-6 in erthropoietic activity, and to evaluate the short-term testosterone therapy. Thirty healthy male Sprague-Dawley rats were divided according to their age into group I [16-week-old; n = 6], group II [48-week-old; n=12], group III [72-week-old; n=I2]. Six rats enrolled in each elderly group [groups II and III] received s.c. testosterone propionate; 2 mg/100 g body weight every other day for 10 days [Groups lIb and Illb]. The remaining rats not received testesterone were named groups [Ila and IlIa]. One day after the last injection, bone marrow aspirates were performed to evaluate the erthropoietic activity and iron stores in the erythroid precursors. In addition, a peripheral haemogram and determination of serum levels of iron, TIBC, IL-6, and free testosterone were done. Significant age-linked changes were observed in the form of decreased serum levels of free testosterone, IL-6, TIBC, RBCs count, and Hb levels as well as an increase in serum iron level in groups Ila and IIla. Bone marrow hypocellularity with a decrease in the amount of iron storage were especially remarkable in Group IlIa. Moreover improvement in the function of erythropoietic tissues in Group lib indicated by erythroid hyperplasia and an increase in the amounts of iron storage. However, reduced serum IL-6 was not affected by testosterone therapy. These data reveal that senile anemias are of hypoproliferaitue character. Testosterone and IL-6 may be, at least in part, the important factors in determining an age-associated decrease in erythropoiesis

Insulin resistance and hyperinsulinemia: independent relation to left ventricular mass in humans

Hyperinsulinemia and insulin resistance may contribute to the development of cardiac hypertrophy which is a major cardiovascular risk factor. In humans, however, the evidence is inconclusive. Antihypertensive drugs have different effects on insulin metabolism, sensitivity, and on left ventricular mass [LVM]. To study the association between LVM and insulin resistance as well as some other cardiovascular risk factors. Also, to compare the effects of two drugs [Atenolol, lisinopril], which have different effects on insulin sensitivity on LVM. The study included four groups: Group [I] control group included 10 healthy lean females aged 35.7+3.4 years. Group [II] included 28 obese normotensive female patients aged 35.39+3.9 1 years, body mass index [BMI] 36.18+3.93 Kg/m2. Group [III] included 28 newly diagnosed obese hypertensive female patients aged 35.85+ 7.8 years, BMI 39.34+4.12 Kg/m2. Group [IV] included 28 newly diagnosed lean hypertensive female patients aged 34.36+4.45 years, BMI 22.98+1.60 Kg/m2. Patients in groups III and IV were randomized to treatment with atenolol or lisinopril [14 patients in each group]. The following parameters were assessed BMI, WHR, systolic and diastolic blood pressure, fasting plasma glucose and insulin, fasting insulin resistance index [FIRI], LVM and left ventricular mass index [LVMI]. Obese and hypertensive patients had significant increase in insulin resistance, LVM and LVMI compared to controls [P<0.05]. Abdominal obesity as repesented by WHR, was directly associated with insulin resistance, LVM, and LVMI [r = 0.749, P<0.001; r = 0.523,P<0.O01; r = 0.656, P<0.001 respectively]. LVM was positively correlated with systolic and diastolic blood pressure, BMI. WHR, and insulin resistance [r = 0.749, P<0.001; r = 0.639, P<0.001; r = 0.224, P = 0.041, r = 0.523, P<0.001; r = 0.509, P<0.001 respectively]. After adjustment for systemic blood pressure and obesity, LVM was independently associated with insulin resistance [P<0.001]; Lisinopril, but not atenolol was associated with favorable effect on insulin resistance and led to more significant regression of LVM in lean [P<0.001] and obese [p = 0:004] hypertesnive patients. LVM has a positive independent correlation with hyperinsulinemia and insulin resistance. Hyperinsulinemia has independent role in promoting left ventricular hypertrophy. Agents and maneuvers which improve insulin sensitivity might be beneficial in management of left ventricular hypertrnphy and other deleterious effects of hyperinsulinemia

Endoscopic variceal ligation versus endoscopic injection sclerotherapy: a prospective study comparing efficacy and safety endoscopic

Patients who have bled from esophageal varices remain at risk for rebleeding. There is interest in methods that would enable rapid control of active bleeding and eradication of esophageal varices. This study included two groups of patients with similar clinical and endoscopic characteristics. One group [28 patients] received endoscopic variceal ligation [EVL] and the second group [22 patients] received endoscopic injection sclerotherapy [EIS]. We compared both methods in terms of efficacy in controlling acute variceal bleeding, associated complications, eradication of varices, recurrence of varices during follow-up, and changes in portal vein blood flow after variceal eradication. Both EVL and EIS were comparable in control of active variceal bleeding [78.6% Vs 81.8%; p= 0.776] and eradication of varices [82.1% Vs 86.4%; p = 0.686]. Rebleeding was more probable to occur with ETS than EVL [7.1% Vs 27.3%; p = 0.054]. ElS was associated with more complications [54.5% Vs 14.3%, p = 0.002]. EVL required less number of endoscopic sessions to eradicate varices [3.82 +/- 0.98 Vs 4.86 +/- 1.36, p = 0.004] but was associated with more recurrence of varices during follow-up period of 8-12 months [35.7% Vs 9.1%], P = 0.029]. The changes in portal vein blood flow were transient after eradication of varices by both procedures. We conclude that while EVL and ElS are equally effective in controlling acute variceal bleeding and eradication of varices, ligation treatment shows greater advantages in the short-term follow up regarding the number of endoscopic sessions required to eradicate varices and the incidence of comp1ications, but is associated with more frequent recurrence of varices in the longer term, These two aspects should be considered for evaluation in the cost/benefits ratio arid quality of life analysis All patients should have frequent endoscopic evaluations [every three or four months] throughout the first year of follow-up

Effects of age and short-term fasting on plasma leptin in obese women and its association with some metabolic cardiovascular risk factors

The study included 22 female obese subjects with body mass index [BMI] ranged from 32-43 Kgm/m2 and age 20-56 years. The effect of 24 h fasting on serum leptin, insulin, and glucose was determined. Also, the correlation between serum leptin and some metabolic risk factors for cardiovascular disease such as lipoproteins and abdominal visceral fat was evaluated. We found that the magnitude of decrease in leptin concentration. with 24 h fasting was much greater than the possible associated loss of body weight induced by fasting. This suggests that other factors modulate leptin secretion other than total adipose mass. The ability of progressive fasting to suppress plasma leptin levels despite a minimal change in adipose mass suggests that ongoing caloric deficiency supersedes total energy reserve in setting chronic levels of satiety and thermogenesis. This regulatory mechanism might have conferred a survival advantage in environments characterized by rapid changes in food availability. Significant correlations were found between abdominal visceral fat measured by computed tomography [CT] and total serum cholesterol, HDL-cholesterol, and triglycerides. However, no association was found between plasma leptin concentrations and both abdominal visceral fat and waist/hip ratio. Also, there was no association between plasma leptin and plasma lipid concentrations. Since plasma leptin concentrations were not related to alterations of plasma lipoprotein concentrations and abdominal visceral which are known risk factors for cardiovascular disease, it does not seem relevant to include leptinemia in the set of metabolic risk factors for cardiovascular disease. Circulating leptin level reflects total adipos tissue mass rather than a combination of adipose tissue mass and distribution

Serum soluble interleukin-2 receptors in patients with acute post streptococcal glomerulonephritis

Serum soluble interleukin-2 receptor [SIL-2R] concentrations were determined in 14 children with acute post streptococcal glomerulonephritis [APSGN] and 10 healthy children of matched age and sex, utilizing ELISA method. The results showed that serum SIL-2R concentration in APSGN cases were significantly higher than in healthy controls and tend to decrease after clinical and urinary improvement. It was found that SIL-2 were negatively correlated with systolic blood pressure and ESR. Moreover, a significant positive correlation between SIL-2 and creatinine clearance was found. These findings suggested that serum SIL-2R can serve as an indicator of activity of APSGN and higher values associated with less morbidity