ABSTRACT
Hemodialysis patients are particularly vulnerable to infection by blood borne viruses including TT-virus and HBV. The continuous HBV infection in these patients in spite of the exclusion of HBs antigen positive patients to separate hemodialysis centers may be contributed by the presence of occult HBV [serum HBs antigen negative but HBV DNA positive]. This study was carried out on 116 chronic hemodialysis patients and 50 healthy controls. After collecting blood from each patient for routine virological assays [HBs antigen, HCV antibodies and HIV1, 2 antibodies], serum was collected and tested for TT-virus DNA by seminested PCR, anti HBc by ELISA and HBV DNA by PCR. In addition, healthy controls were tested for serum TT-virus DNA by seminested PCR. Thirty three [28.4%] hemodialysis patients were positive for TT-virus DNA compared to 8% of the healthy controls [P=0.004]. However, the prevalence of detection of HBV DNA, HBs antigen and anti HBc was 6%, zero% and 12.9%, respectively. In addition, a high prevalence of HCV seropositivity [65.5%] was detected. None of the patients was positive for HIV1, 2 antibodies. TT-virus DNA positive patients had higher mean number of previously received blood transfusions than TT-virus DNA negative patients [P=0.016]. No statistically significant differences were present between TT-virus positive and negative patients regarding age, sex, duration of hemodialysis, prevalence of HBV DNA, anti HBc and anti HCV positivity or mean ALT level and prevalence of elevated ALT. The eight patients with TT-virus infection alone [negative for HCV antibodies and HBV DNA] had normal ALT levels and no clinical evidence for hepatic disease. However, coinfection by HCV could account for ALT elevation in patients with TT-virus infection. We detected 7 [6%] hemodialysis patients with occult HBV infection. Among these patients, anti HBc seropositivity was detected in 5 patients [71.4% versus 9.2% in patients without occult HBV infection, P=<0.001]. No statistically significant differences were found between patients with and without occult HBV infection concerning age, sex, number of previously received blood transfusions, duration of hemodialysis, prevalence of TT-virus DNA and anti HCV positivity or mean ALT level and prevalence of elevated ALT. Only one patient with occult HBV infection had elevated serum ALT level. However, this patient was also positive for HCV antibodies. We concluded that TT-virus infection is common in Egyptian hemodialysis patients. Apart from the number of previously received blood transfusions, no demographic, clinical or virological factor was found to be significantly correlated with TT-virus infection. TT-virus does not seem to cause a significant liver disease. However, other studies are needed to investigate the possible enhancing effect of this virus on hepatic disease caused by HCV in these patients. Moreover, occult HBV infection occurs at a low frequency in Egyptian hemodialysis patients with no association with demographic or clinical findings, TT-virus or anti HCV positivity. Anti HBc testing does not seem to be valuable in detecting occult HBV infection. Screening of hemodialysis patients for HBV DNA is recommended for more strict control of HBV infection in these patients
ABSTRACT
This study included 37 patients with cirrhosis and normal renal function tests divided into three groups based on a modified Child- Pugh classification [12 of Child's grade A, 12 of Child's grade B and 13 of Child's grade C], in addition to 12 healthy individuals of matched age and sex as controls. Renal ultrasound Doppler examination with an estimation of the mean intrarenal resistive index [RI] was done to all patients and controls. There was a significantly increased RI in the patient groups [A, B and C] versus the control. RI was 0.534 +/- 0.063, 0.681 +/- 0.279, 0.783 +/- 0.1075 and 0.459 +/- 0.106, respectively. Also, RI was significantly increased in grade C than A and B, respectively. So, the index showed a significant correlation with the increased Child-Pugh grading and the resistive index was closely related to the severity of cirrhosis and the degree of ascites. Therefore, it is considered a useful index of assessing renal hemodynamics in patients with cirrhosis