Uric acid metabolism in a sample of Egyptian hypertensive patients with normal kidney function

Hyperuricemia is commonly associated with hypertension. Also, it is well known to coincide with the metabolic syndrome but is still not recognized as a risk factor. So, we aimed to evaluate hyperuricemia among a sample of hypertensive Egyptians with normal renal function. This study was performed on 303 hypertensive patients aged 30-69 years. Patients were divided into 2 groups according to the level of uric acid: group 1 composed of 168 hypertensive hyperuricemic patient sand group 2 composed of 135 hypertensive normouricemic patients. All patients were subjected to complete medical history and detailed clinical examination including body mass index [BMI], complete blood count [CBC], serum creatinine, BUN, FBS, cholesterol, triglycerides, uric acid, sodium, potassium, urinary uric acid, urinary creatinine, urinary uric acid to creatinine ratio and fractional excretion of uric acid[FEUA]. The overall prevalence of hyperuricemia was 55.4%. Uric acid correlated significantly with age [p<0.05]. BMI was significantly higher in group1 than in group 2 [p<0.05], and there was a significant positive correlation between serum uric acid and BMI [p<0.01].Serum triglycerides and cholesterol were significantly higher in group 1 than in group 2 [p<0.05for both] denoting risky metabolic effects. Serum uric acid correlated significantly with systolic blood pressure [p<0.05], but not with diastolic blood pressure. No significant difference found between group 1 and group 2 as regards SBP, DBP or blood pressure control [all p values > 0.05]. Serum uric acid found to correlate significantly [p<0.001] with urinary uric acid, urinary creatinine and negatively with FEUA denoting early tubular defect of the kidney. Also, Urinary uric acid, urinary creatinine and urinary uric acid/creatinine ratio were higher in group 1than in group 2 [p values were<0.001, <0.001 and <0.05 respectively]. FEUA was found to be significantly lower in group 1 than in group 2 [p<0.01]. We found, also, that serum sodium level was significantly higher in the hyperuricemic group than in the normouricemic group [p<0.001] denoting the role of Na[+] in the development of hypertension and defective renal excretion of uric acid. We conclude that the incidence hyperuricemia in our sample of Egyptian hypertensive patients was [55.4%]. Impaired renal clearance of uric acid occurs before deterioration of GFR. Serum uric acid should be measured in all cases of hypertension together with BMI, total cholesterol, triglycerides and should be treated to avoid consequent metabolic complications. Hypertensive patients with hyperuricemia should be warned strictly of high sodium diet

Plasma Ghrelin level; anorexigenic and orexigenic mediators in patients with end stage renal failure on hemodialysis

Anorexia-associated malnutrition is a severe complication that increases mortality in hemodialysis [HD] patients. Ghrelin is a recently-discovered orexigenic hormone with actions in brain and stomach. We analyzed, in 22 HD patients, the possible relationship between ghrelin and appetite regulation with regard to other orexigens [NO3] and anorexigens [cholecystokinin [CCK], leptin, glucose-dependent insulinotropic peptide [GIP]. All orexigens and anorexigens were determined in plasma. Eating motivation was evaluated using a visual analog scale [VAS]. The patients were divided into three groups: those with anorexia [n = 8], those with obesity associated with high intake [n = 5], and those with no eating behavior disorders [n = 9]. A control group of 10 healthy volunteers was also evaluated. Mean plasma levels of ghrelin were high [4101 +/- 1233 mg/mL], with the patients showing values above the control group range [1920 +/- 451mg/mL]. Patients with anorexia had lower ghrelin level and higher CCK and GIP levels than did the other patients. Patients with anorexia also had an early satiety score and low desire and pleasure in eating on the VAS and diet survey. We observed significant positive linear correlations between ghrelin and albumin [r = 0.43, p < 0.05], growth hormone [r=0.66, p < 0.01], NO3 [r = 0.36, p < 0.05], and eating motivation [VAS]. At the same time, negative relationships were observed between blood ghrelin and GIP [r = -0.42, p < 0.05], insulin [r = -0.4, p < 0.05], and leptin [r = -0.45, p < 0.05]. Ghrelin levels were not related to levels of CCK. Ghrelin plasma levels are elevated in HD patients. Uremic patients with anorexia show relatively lower ghrelin plasma levels than the levels seen in obese patients or in patients with normal appetite. The role of ghrelin in appetite modulation is altered in uremic HD patients, and that alteration is possibly associated with disorders in insulin and growth hormone metabolism