Hyperhomocysteinemia in chronic renal failure and its role in repeated vascular access thrombosis in patients on regular hemodialysis

This study was performed on 79 patients with chronic renal failure [CRF] in Assiut University Hospital through the year 2006-2007 in the dialysis unit and 20 apparently healthy subjects as a reference group, they were classified as following: Group I; 20 healthy subjects, Group II; 24 patients who will start dialysis for the first time, Group III; 55 patients on maintenance hemodialysis for more than 3 years. Group III was sub-classified according to the presence of repeated arterio-venous fistula occlusion and thrombosis into: Group III a; 25 patients without repeated arterio-venous fistula occlusion and, Group III b; 30 patients with repeated [3 or more] fistula occlusion. After careful history and clinical examination, the following was done: A] Routine investigations: Peripheral hemogram, serum glucose, urea and creatinine and creatinine clearance, total serum protein and serum albumin as well as serum lipidprofile. B] Special investigations: total plasma homocysteine. The results of this study showed no significant difference when comparing group IIlb with group IlIa regarding kidney function [serum urea, creatinine and creatinine clearance], serum total protein and albumin as well as all components of the lipid profile. Homocysteine showed highly statistically significant elevation when comparing each of groups II, IIIa and Illb with group I, but there was no statistically significant difference when comparing group II with group III. However, there was highly statistically significant elevation when comparing group III b with group III a. We concluded that hyper-homocysteinmia in patients with end stage renal disease could be considered a risk factor for the development of repeated vascular access thrombosis [VAT] or occlusion

Assessment of total plasma homocysteine and nitric oxide levels as a risk factors in coronary heart disease

This study was performed on 40 patients suffering from Coronary heart disease [CHD] and 20 primary asymptomatic hyperlipidemia subjects compared with 20 age and sex matched healthy persons as a control group [group I]. Patients were classified into three groups: Group III: Twenty patients with acute myocardial infarction [AMI]. Group II: Twenty patients [6 with stable angina [group III[a]], and 14 with unstable angina [group III[b]] Group IV: Twenty patients with primary hyperlipidemia, without clinical and ECG evidences of ischaemic heart disease [IHD]. All patients and control groups were subjected to clinical examination, ECG: serum glucose level, Kidney, liver function tests, lipogram, CK, CK-MB and C-reactive protein, nitric oxide, [NO] and Total plasma homocysteine [tHcy] Serum total cholesterol and LDL-c levels showed statistically significant elevation in groups II, III and IV when compared with the control group. Also, serum CH, LDL-c and Triglyceride [TG] showed highly significant elevation in group IV when compared with group II and III while 9 TG was signficantly elevated only in group III compared with control Serum HDL-c revealed statistically significant reduction in all patient groups when compared to the control group, but no significant difference was observed on comparing different patient groups together. CK, CK-MB and CRP levels revealed highly significant elevation in group II and group III[b], and group IV when compared with the control group. No significance difference was observed on comparing group III[a] with the control group. Also the same parameters showed significant elevation in group II when compared with groups III[a] III[b] and IV. Also there was highly significant elevation in group III[b] when compared with group IV. But no significant difference was observed on comparing group III[a] with group IV. Serum nitric oxide [NO] revealed highly significant elevations in groups III[a], III[b] and IV when compared with the control group, while no significant difference was observed between group II and the control group. Serum NO level showed no significant difference in other patient groups when compared with each other. Homocysteine showed highly significant elevation in all patient groups when compared with the control group. In group II plasma tHcy levels showed significant elevation when compared with groups III[a],III[b] and IV. Moreover patients in group III[b] showed significant elevation when compared to group IV. Hyperhomocysteinemia is found in most of the patients with CHD and in cases of primary hyperlipidemia. So tHcy can be used as a risk factor for prediction of CHD. Also it is related to severity of CHD as it showed the highest sensitivity in AMI

Survey study of microalbuminuria in diabetic patients attending out-patient clinic of diabetes in Assiut University Hospital

Micro albuminuria is the earliest sign of diabetic nephropathy [DNP] and it is an indicator for the presence of the characteristic glomerular lesion. This study was conducted on the adult diabetic patients of both types I and II of diabetes mellitus [DM] attending the out -patient clinic of Assiut University Hospital throughout the year 2002. Patients with hypertension, congestive heart failure or those with urinary tract infection albuminuria were excluded. Five hundred patients were subjected to full history taking and clinical examination as well as the following investigations; [I] complete urine analysis [2] screening for micro albuminuria [3] fasting serum glucose [FSG]] and glycosylated hemoglobin [HbAlc] [4] serum urea and creatinine and creatinine clearance. Out of 500 patients 213 [42.6%] were positive for micro albuminuria which was more prevalent among type I DM, male sex, extreems of age, urbans, over-weight and obese patients and those with low physical activities as well as patients with non renal complications. Significant direct proportions were found between level of micro albuminuria, on one hand, and level of FSG and HbAlc and serum urea and creatinine on the other hand, while inverse proportion was found with creatinine clearance. We have concluded that, micro albuminuria is a simple detectable marker for screening incipient DNP. Micralbuminuria was prevalent among considerable percentage [42.6%] of our diabetic patients. It was found to be more prevalent among different studied categories of patients which could be considered as possible risk factors for developing DNP in our locality. Apart from hypertension, these factors are [1] type I DM [2] male sex [3] extreems of age [4] urbans [5] low physical activities [6] obesity [7] long duration of DM [8] bad control of hyperglycaemia [9] presence of non renal complications [10] renal insufficiency