Transferrinuria in type 2 diabetes mellitus: An early marker of diabetic nephropathy

Diabetic nephropathy is the commonest cause of end-stage renal failure in the Western world. The incidence of DN rises rapidly over the first 15 to 20 years of diabetes to decline sharply afterwards. The stages of DN progress from normoalbuminuria to microalbuminuria to clinical proteinuria and finally to end-stage renal failure. Several studies proved the applicability of urinary albumin quantification in the early diagnosis of diabetic nephropathy. Several studies of different urinary proteins demonstrated the increased excretion of other high and low molecular mass proteins in different stages of diabetic nephropathy: macromolecular, e.g. transferrin and micromolecular proteins like alpha 1-microalbumin. Elevated urinary transferrin excretion rates have been reported in patients with type 2 diabetes and its complications. Therefore, the aim of the present study was to evaluate the role of transferrin as an early marker for the detection of nephropathy in Egyptian type 2 diabetic patients. Sixty Egyptian type 2 diabetic patients grouped according to the presence or absence of albumin in urine into three groups: group I consisted of 20 normoalbuminuric Egyptian type 2 diabetic patients, group II included 20 microalbuminuric Egyptian type 2 diabetic patients, and group Ill comprised 20 macroalbuminuric Egyptian type 2 diabetic patients. Twenty healthy subjects of matched age and sex were included as a control group. Laboratory investigations included FBG and 2 hours PPBG, HbA[1C] serum albumin, ALT, AST, prothrombin activity, blood urea, serum creatinine and creatinine clearance, and complete urine analysis. Determination of microalbuminuria in fresh urine samples was done using immunoturbidimetry. Estimation of urinary transferrin was done by immuno-nephelometry. Results: Type 2 diabetic patients who had frank proteinuria had a significantly longer duration of diabetes mellitus as compared to micro and norrnoalbuminuric patients. Type 2 diabetic patients with frank proteinuria had significantly higher FBG, PPBG and HbA[1C] levels as compared to normoalbuminuric type 2 diabetic patients and controls. Type 2 diabetic patients with frank proteinuria had significantly higher blood urea and serum creatinine and a significantly lower creatinine clearance as compared to norrnoalbuminuric type 2 diabetic patients and controls. Type 2 diabetic patients with frank proteinuria showed significantly higher urinary albumin and transferrin excretion as compared to normo-and microalbuminuric type 2 diabetic patients and controls. Also, microalbuminuric type 2 diabetic patients had significantly higher urinary albumin and transferrin excretion as compared to normoalbuminuric type 2 diabetic patients and controls. In normoalbuminuric type 2 diabetic patients, a negative correlation was observed between creatinine clearance and transferrinuria. In microalbuminuric type 2 diabetic patients, a strong positive correlation was found between albuminuria and transferrinuria. In type 2 diabetic patients with frank proteinuria, strong positive correlations were obtained between blood urea and serum creatinine and transferrinuria, while a strong negative correlation was observed between creatinine clearance and transferrinuria. However, no significant correlations were found in any of the type 2 diabetic groups between duration of the disease, blood pressure, FBG, PPBG, or HbA[1C] and transferrinuria. Urinary transferrin is a convenient diagnostic parameter of renal impairment in Egyptian type 2 diabetic patients. Transferrinuria could be considered as an early marker of diabetic nephropathy as compared to microalbuminuria

DNA polymorphism of the lipoprotein lipase gene and of the apolipoproteins AI, CIII, AIV genes cluster in Egyptian cad patients and in healthy control subjects

Coronary artery disease [CAD] is a major cause of mortality in Egypt. CAD is a multifactorial disorder with both environmental and genetic factors involved in its aetiology and pathogenesis. Dyslipidaemias are among the major risk factors for CAD. Lipoprotein lipase [LPL] gene an apolipoprotein AI-CIII-AIV genes cluster are among the main candidate genes involved in lipid metabolism. The aim of the present study is to determine and detect the frequencies of common DNA polymorphisms of LPL gene and apo AI-CIII-AIV gene cluster in Egyptian CAD patients and healthy control subjects. The study sample included 121 Egyptian male CAD patients and 101 male controls. Mutations and polymorphisms that were previously found to be common in European or Asian populations were chosen to be examined in the current study. These included D9N, N291S, S447X, and Hindlll restriction fragment length polymorphism [RFLP] for LPL gene. Those for the apolipoprotein AI-CIII-AIV genes cluster were: Xmnl RFLP, Al promoter 75G>A, Mspl RFLP, and Pstl RFLP for apo al, Sstl RFLP for apo CIII, and T347S For apo AVI. The N291S and the homozygous pattern of the rare allele of S447X reported in other ethnic groups were not detected in the studied groups. The frequencies of other mutations and polymorphism were reported. Some of these frequencies are comparable with other reported frequencies in the literatures of other ethnic groups. However, there were no statistical significant difference between the CAD patients and the normal males. Failure of the present study to detect significant association between the different polymorphic sites and CAD reflects the complexity of the disease where other environmental and genetic factors may be involved

Protein C deficiency in thrombotic and embolic cerebrovascular strokes

To examine the possible pathophysiologic role of protein C-a natural anticoagulant- in thromotic and embolic cerebrovascular strokes, we studied 20 patients with acute stroke [10 subjects with thrombotic stroke, and 10 others with embolic stroke]. Prothrombin time, activated partial thromboplastin time [APTT], plasma fibrinogen, plasma protein C activity, and serum fibrin [ogen] degradation products [FDP[s]] were measured in these subjects and were compared to those in 10 healthy volunteers. Prothrombin time and APTT were comparable in all groups. Plasma fibrinogen and serum FDP[s] were significantly increased, and plasma protein C activity was significantly diminished in the thrombotic and embolic stroke patients in comparison to healthy individuals. Although these hemostatic alterations can be secondary to thrombin generation in thrombotic and embolic strokes, yet they may share in the initiation or perpetuation of the pathophysiologic process involved in the genesis of these strokes

Triglyceride clearance in chronic renal failure

The clearance of exogenous triglycerides from the blood was studied after intravenous infection of intralipid in three groups of subjects. The first group included seven healthy controls, the second group comprised ten patients with chronic renal failure [CRF] on conservative medical treatment [CMR] and the third group consisted of six patients with end stage renal disease [ESRD] on maintenance hemodialysis [MH]. All controls and patients had normal fasting serum triglyceride level except one patient with CRF on CMR who had hypertriglyceridemia with an incidence of 6.3%. This was planned to eliminate the effect of hypertriglyceridemia perse on the fractional turnover rate of intralipid [K2]. The present study has shown that CRF patients with normal fasting serum triglyceride [TG] level and on CMR have impaired TG clearance that correlated negatively with their fasting serum TG levels, while those on MH have a normal TG clearance. results were discussed and compared with previous studies done on the same topic

Effect of unilateral ureteral obstruction on plasma and kidney tissue sodium, potassium levels and on renal sodium-potassium adenosine triphosphatase activity in rats

The present study was carried out on 20 male albino rats divided into two groups. Sham operated control [10 rats] in which the ureter was visualized but not ligated. The other group [10 rats] the animals were exposed to unilateral obstruction for 48 hours after which blood samples were collected, and both kidneys in each rat were removed. In the unilateral ureteral obstruction group, significant decrease of kidney tissue levels of Na + and K + as well as significant decrease of Na + - K + ATPase activity in kidney cortex and outer medulla tissue homogenate with nonsignificant changes in plasma Na + and K + levels were detected as compared to contralateral kidney and sham operated control group. While, in the contralateral kidney, cortex and outer medulla homogenate and insignificant changes of kidney tissue K + were detected as compared to sham operated control group. Results were fully discussed

Electroencephalogram and O2 uptake of normal rat brain under the effect of some depressant drugs, neurotransmitters and uraemic toxins

The present work was undertaken to record the effect of some central depressant drugs and neurotransmitters on EEG and O2 uptake of normal rat brain. EEG changes of rat brain under the influence of some uremic toxins were also determined. Phenobarbitone, diazepam and chlorpromazine caused significant damping of EEG amplitude and O2-uptake of the normal rat brain. The neurotransmitter acetyl choline resulted in a significant diminution of both EEG amplitude and O2-uptake, while atropine sulphate did not change both. Serotonin caused significant caused significant reduction of O2-uptake of rat brain tissue, while epinephrine increased it significantly as compared to controls. Uremic toxins, urea, uric acid, phenol, ethanolamine and 5-hydroxy indol acetic acid reduced significantly EEG amplitude of rat without changes in frequency, except creatinine which did not result in any significant changes. Similarity between the mode of action of both uremic endotoxins and depressant drugs through central neurotransmitters was suggested. Results were fully discussed

Serum lipids, lipoproteins and apolipoproteins in the elderly Egyptians

Serum lipids, lipoproteins, triglycerides and apolipoproteins A and B were studied in 120 apparently normal individuals divided into three groups according to ages: Elderly, middle aged and young groups. The study showed a significant decrease in total cholesterol, VLDL-C, LDL-C, triglycerides apolipoprotein B in the elderly males in relation to middle aged control, yet some of these parameters did not show significant variation in relation to young control, while% HDL-C and the concentration of Apo A, showed a significant increase in the elderly males when compared to middle age control. Triglyceride showed a significant decrease in the elderly females when compared to middle aged and young control yet Apo B showed significant decrease in the elderly female in relation to middle aged control only. The% HDL-C showed significant increase in the elderly female, while other parameters did not show variation with sex. The high level HDL-C and Apo A, may possibly contribute to low morbidity and longevity in the elderly individuals studied

Effect of splenectomy on platelet antibodies and serum immunoglobulins in schistosomiasis

The preset trial was carried out to detect the presence of platelet antibodies and to assess serum immunoglobulins in schistosomiasis before and after splenectomy. The study included 50 male cases with schistosomal hepatosplenomegaly and 10 normal male subjects as controls. Splenectomy was performed in 10 cases showing evidences of hypersplenism. Moderate thrombocytopenia was observed in all schistosomal cases. Platelet antibodies were detected in 30% of schistosomal cases associated with marked thrombocytopenia. Serum immunoglobulin G and M were significantly increased in bilharzial patients as compared to controls, which was more pronounced in respect to IgG in cases having platelet antibodies. Following splenectomy, significant increase of platelet count and significant reduction of platelet antibodies were found without any associated changes in serum immunoglobulins. Results were fully discussed

Atherogenic effect of cigarette smoke exposure and high salt intare using the rabbit as an experimental model

The effect of cigarette smoke exposure and high salt intake, either singly or in combination, were assessed on some atherogenic factors. Significant increases in total cholesterol were found in all treated groups. When combined cigarette smoke exposure and high salt intake had an additive effect. This was combined with a lack of effect on HDL cholesterol. Cigarette smoke exposure resulted in a 28% increase in serum triglycerides. Although high salt intake alone was without effect on this parameter, it had a synergistic effect when combined with cigarette smoke exposure. Platelet aggregation was significantly increased after cigarette smoke exposure, high salt diet intake and their combination. Significant decrease of prothrombin time and partial thromboplastin time were recorded after high salt intake and its combination with cigarette smoke exposure, which may denote increase tendency for thrombus formation. Results were fully discussed

Determination of the oxygen consumption in the gingival tissue of diabetic patients

The research was planned to study the gingival condition of diabetics clinically, to estimate gingival tissue respiration in diabetes and to clarify the effect of severity of the disease of the gingiva. Present results revealed an increase in the pocket depth, loss of attachment and tooth mobility in the diabetic groups [controlled and uncontrolled diabetics] as compared with the non-diabetic persons. There is an increase in the gingival index in the diabetic group. The oxygen consumption of the gingival tissue of the controlled and uncontrolled diabetics was significantly decreased as compared to that of the non-diabetic subjects. Explanation of these results was discussed and explained

Effect of chronic exposure of rabbits to hashish smoke on some hematological aspects, blood lipids and lipoprotein lipase activity

The effect of chronic exposure of rabbits to hashish smoke every other day for 30 days, was investigated on blood count, plasma lipids and lipoprotein lipase activity. The red cell count as well as the haemoglobin content decreased significantly. The total leucocytic count was not altered, yet the differential count showed a significant rise of polymorphs, together with a significant decrease of lymphocytes. Regarding lipids, the plasma free fatty acids [FFA] and lipoprotein lipase activity decreased significantly, while the total plasma cholesterol and triglycerides did not change. These results were discussed