B cell-associated immune profiles in patients with end-stage renal disease (ESRD)

Most of the previous studies on immune dysregulation in end-stage renal disease (ESRD) have focused on T cell immunity. We investigated B cell subpopulations in ESRD patients and the effect of hemodialysis (HD) on B cell-associated immune profiles in these patients. Forty-four ESRD [maintenance HD patients (n = 27) and pre-dialysis patients (n = 17)] and 27 healthy volunteers were included in this study. We determined the percentage of B cell subtypes, such as mature and immature B cells, memory B cells, and interleukin (IL)-10+ cells, as well as B cell-producing cytokines (IL-10, IL-4 and IL-21) by florescent activated cell sorting (FACS). B cell-associated gene expression was examined using real-time PCR and B cell producing cytokines (IL-10, IL-4 and IL-21) were determined using an enzyme-linked immunosorbent assay (ELISA). The percentage of total B cells and mature B cells did not differ significantly among the three groups. The percentages of memory B cells were significantly higher in the pre-dialysis group than in the HD group (P 0.05) between the two subgroups within the ESRD group, but the serum IL-10 concentration was significantly lower in the pre-dialysis group (P < 0.01). The results of this study demonstrate significantly altered B cell-associated immunity. Specifically, an imbalance of immature and memory B cells in ESRD patients was observed, with this finding predominating in pre-dialysis patients.

Inflamação na doença renal crônica: papel de citocinas / Inflammation in chronic kidney disease: the role of cytokines

A doença renal crônica (DRC) é um grave problema de saúde pública cuja prevalência tem aumentado nos últimos anos. Apresenta caráter progressivo e está associada à elevada morbidade e mortalidade. Inúmeros fatores estão associados à instalação e progressão da DRC, tais como obesidade, hipertensão arterial e diabetes mellitus. Além desses fatores, existem evidências de inflamação na fisiopatologia da DRC. Diversas citocinas e quimiocinas têm sido detectadas no plasma e urina de pacientes em estágios precoces da DRC e também relacionadas às complicações da doença. A expressão desses mediadores e a lesão renal sofrem interferência de fármacos como inibidores de enzima conversora de angiotensina (ECA), estatinas e antagonistas de receptores de citocinas. A modulação da resposta imuno-inflamatória pode se tornar alvo para tratamento da DRC. O objetivo deste artigo de revisão foi resumir as evidências científicas do pa-pel da inflamação na DRC, destacando-se os efeitos de citocinas e quimiocinas.

Chronic kidney disease (CKD) is a serious public health problem whose prevalence has increased in the last few years. Its progression is associated with high morbidity and mortality. Several factors are associated with the onset and progression of CKD, such as obesity, hypertension and diabetes mellitus. Beyond these factors, there is evidence of a pathophysiological role for inflammation in CKD. Several cytokines and chemokines have been detected in the plasma and urine of patients at early stages of CKD, and have also been related to CKD complications. The expression of these mediators and renal injury may be influenced by drugs such as angiotensin-converting enzyme inhibitors, statins and antagonists of cytokine receptors. Modulation of the immune-inflammatory response can become a target for CKD treatment. The aim of this study was to review the scientific evidence on the role of inflammation in CKD, especially the effects of cytokines and chemokines.

Diagnóstico da hepatite C em pacientes com doença renal crônica em hemodiálise: qual a melhor estratégia? / Diagnosis of hepatitis C in hemodialysis patients with end-stage renal disease (ESRD): what is the best strategy?

hepatite (HCV), comparados à população em geral, face à exposição frequente ao sangue e à contaminação nosocomial. Entretanto, o diagnóstico da hepatite C nesses pacientes é dificultado por sintomas inespecíficos, valores normais de alanina aminotransferase (ALT), na maioria dos casos, sorologia falso-negativa e baixa viremia. Objetivo: definir e avaliar a acurácia dos métodos diagnósticos da hepatite C em pacientes em HD. Métodos: foram avaliados 500 pacientes com DRC em HD, com anti HCV negativo, histórico e prospectivo de três meses, e avaliação de uma amostra de HCV RNA qualitativo e ALT mensal durante o seguimento. Foram excluídos pacientes com diagnóstico prévio de hepatite B e C, HIV, transplantados, em diálise peritoneal e com acesso venoso por cateter duplo-lúmen. Resultados: o tempo médio de HD foi de 48,8 ± 41,2 meses; ALT revelou-se normal em 92%; anti-HCV e HCV RNA negativos em 99,8% dos pacientes; apenas um paciente (0,2%) apresentou viremia positiva, ALT normal e anti HCV falso-negativo durante o período de seguimento. Conclusões: o teste anti-HCV e a ALT não detectaram precocemente a hepatite C em paciente renal crônico com viremia positiva, o que pode ser explicado pelo comprometimento da resposta imune associada à uremia, ou devido ao período prolongado de janela imunológica antes da soroconversão. Entretanto, o valor preditivo negativo do anti-HCV foi alto, sugerindo que uma redução no intervalo de seis meses da dosagem do anti-HCV pode ser uma estratégia para o monitoramento e a detecção precoce da hepatite C nesses pacientes

Introduction: Patients with end-stage renal disease (ESRD) on hemodialysis (HD) are at a higher risk of infection with hepatitis C virus (HCV), when compared to the general population, due to frequent blood exposure and nosocomial infections. However, the diagnosis of hepatitis C in those patients is very difficult due to non-specific symptoms, normal alanine aminotransferase (ALT) levels, in most cases, false-negative serology, and low viral load. Objective: To define and evaluate the accuracy of hepatitis C diagnostic methods on HD patients. Methods: Five hundred HD patients with ESRD, negative anti-HCV in the past, and, for the next three months, underwent monthly qualitative HCV RNA and ALT testing during follow-up. Patients with a diagnosis of hepatitis B and C, HIV, with kidney grafts, in peritoneal dialysis, and with venous access with double-lumen catheter were excluded. Results: Mean time of HD was 48.8 ± 41.2 months; it was detected normal ALT in 92% of patients; negative anti-HCV and HCV RNA in 99.8% of patients; only one patient (0.2%) showed positive viremia, normal ALT, and false-negative anti-HCV during the follow-up period. Conclusions: Anti-HCV and ALT did not allow early detection of hepatitis C in a patient with ESRD and positive viremia, which can be explained by the disruption of the immune response associated with uremia or due to the prolonged immunologic window before seroconversion. However, anti-HCV showed a high negative predictive value, suggesting that a reduction in the six-month interval of the anti-HCV test could be a strategy for monitoring and early detection of hepatitis C in those patients

Efficacy of intradermal hepatitis B vaccination compared to intramuscular vaccination in hemodialysis patients.

BACKGROUND: Hepatitis B virus infection remains an important problem in hemodialysis patients. Only 50 to 60% of the patients develop seroconversion (anti-HBs Ab titer > 10 IU/L) after intramuscular hepatitis B vaccination. Small dose intradermal inoculation method of hepatitis B vaccine has been reported to be effective as well as economical, and could provide rapid seroconvesion of immunity. The aim of the present study was to compare the efficacy of intradermal hepatitis B vaccination with intramuscular vaccination in hemodialysis patients. MATERIAL AND METHOD: Fifty one hemodialysis patients were randomly assigned to two groups, 25 patients received a total 7 doses of 10 mmicrog of recombinant hepatitis B vaccine (Engerix B) intradermally every 2 weeks (ID group), whereas 26 patients received 40 microg intramuscularly at 0, 1, 2 and 6 months (IM group). Anti-HBs Ab titer was measured at 2, 3, 4 and 7 months after the first vaccination in both groups. Vaccination responses were classified into 3 subgroups according to anti-HBs Ab titer and these included excellent response (> 1,000 IU/L), good response (10-999 IU/L) and non-response (< 10 IU/L). RESULTS: The seroconversion rates at 2, 3, 4, and 7 months in the ID group were 56%, 76%, 88%, and 92% compared with 31%, 42%, 65%, and 69% in the IM group, respectively. Only the seroconversion rates at 3 months were significantly higher in the ID group (76% versus 42%, p = 0.03). At 7 months after the first vaccination, good and excellent responders in the ID group were 72% (18/25) and 20% (5/25) compared with 34.5% (9/26) and 34.5% (9/26), respectively (p > 0.05). Only minor side effects were observed. CONCLUSION: Seven doses of 10 mg intradermal vaccination induced a high seroconversion rate and were comparable with intramuscular regimen. Intradermal vaccination may be helpful for the rapid induction of protective level of antibodies and may be a cost-saving alternative to intramuscular vaccination in hemodilaysis patients.

Tuberculosis: a resurgent disease in immunosuppressed patients.

A total of 136 patients, 67 HIV, 69 diabetes mellitus (DM) with or without (+/-) end-stage renal disease (ESRD), were registered for tuberculosis treatment at the National Tuberculosis Center (NTBC) from May to December, 2003. Ages ranged from 21-78 years (median 57.7 years) in TB/DM patients, and 21-62 (mean 37.6 +/- 8.3 years) in TB/HIV patients. TB was significantly found in younger and single HIV patients, but in older and married DM patients (p<0.05). Male patients in both groups were strongly associated with TB, while females more commonly had TB with DM (p<0.05). The majority of these patients were Malays, unemployed, and resided in Kuala Lumpur territory; however, no statistically significant difference was found between the 2 groups. Smoking, IVDUs and hepatitis C virus (HCV) infection were more significantly found in TB/HIV patients and further analysis showed that pulmonary TB was strongly associated with HCV infection in these patients (p<0.05). Pulmonary TB (62; 89.9%) was the most common type found in both groups and was a markedly more common disease location in TB/DM patients, while extrapulmonary TB (21; 31.3%) and miliary TB (14; 21%) were significantly higher in TB/HIV patients. Cough with or without sputum, fever and loss of appetite and/or weight were common clinical presentations in both groups. Nevertheless, fever (54; 80.6%) and lymphadenopathy (17; 25.4%) were significantly related to TB/HIV patients (p<0.05). Interestingly, the presence of BCG vaccination and positive tuberculin skin test were stronger in TB/HIV (27; 40.3%) and TB/DM (20; 29%) patients, respectively (p<0.05). Overall, regular 6-, 9- and 12-months' anti-tubercular therapy (ATT) were routine practice, and EHRZ+B6 was the most common regimen used. The highest percentage of patients with treatment success were in both groups with 6 months' ATT; however, a significantly higher percentage was found in TB/DM (24; 34.8%) than TB/HIV (13; 19.4%) (p<0.05). A success rate of 15 (21.7%) was noted for TB/DM patients with 9 months' ATT, which was similar to both groups with the 12-month regimen. A higher percentage failure rate (lost to follow-up) was seen in TB/HIV (19; 28.4%) patients. Nine patients were reported to have anti-tubercular-drug side-effects, such as drug-induced hepatitis, blurred vision, and skin rash. No cases of drug resistance or death were notified among these patients.

Antiphospholipid antibodies in Egyptian patients with chronic renal failure

The objectives of present research was to detect the incidence of antiphospholipid antibodies among Egyptian patients with chronic renal failure and its relation to their clinical manifestation and vascular access thrombosis. This study including 80 patients with chronic renal disease divided into two groups. Group A, forty patients with impaired renal function and group B, forty patients in chronic renal failure on hemodialysis. In addition to 10 age and sex matched subjects as a control group. All of them were subjected to clinical examination and laboratory investigation including antiphospholipid antibodies. Lupus anticoagulant was present in 21.25%, aCL IgM in 18.75% while aCL IgG in 11.25% of whole chronic renal disease patients. There was higher incidence of antiphospholipid antibodies in-group B end stage renal failure on hemodialysis [28/40[70%]] compared to group A of renal impairment [25/40[62.5%]]. Also there was insignificant relationship between antiphospholipid antibodies and age, kidney function or liver function tests. There is increase of antiphospholipid antibodies among patients with chronic renal failure with great liability for thrombosis of vascular access. Also patients with positive LA have a great possibility to be hypertensive. HCV infection in hemodialysis group may be the cause of increased incidence of antibodies. Antiphospholipid antibody profile should be done for patients with recurrent thrombosis of vascular shunt, as it is the main cause of hospitalization of dialysis patients

Prevalence of HBV and HCV dual infection in patients on haemodialysis.

Hepatitis viral infections are important causes of morbidity and mortality in haemodialysis patients. One hundred and thirty four patients attending haemodialysis unit were screened for the presence of HBV and HCV infections. Eight (5.9%) patients were HCV positive while two (1.4%) patients had HBV infection. A dual infection with both the viruses was observed in five patients (3.7%).

Anti-Toxoplasma gondii antibodies in hemodialysis patients receiving long-term hemodialysis therapy in Turkey

Toxoplasma is a globally distributed pathogen for humans and animals. In situations of immunodeficiency, Toxoplasma gondii [T. gondii] emerges as a life-threatening infection. Toxoplasma gondii is transmitted parenterally, flourish in state immunosuppression and, most toxoplasma infections are asymptomatic. In the present study, we aimed to investigate the prevalence of anti-T. gondii antibodies in hemodialysis patients with chronic renal failure. We undertook a prospective study of our maintenance hemodialysis patients to determine whether these sources posed a risk for transmission of T. gondii. This study was carried out on patients undergoing regular hemodialysis in the dialysis units [Hemodialysis Center of Antakya State Hospital, Emir Hemodialysis Center and Antakya Hemodialysis Center, Hatay, Turkey] between January 2004 and June 2004. Two hundred and fifty-five hemodialysis patients and 50 healthy controls were studied for the prevalence of anti-T. gondii antibodies by enzyme-linked immunosorbent assay. Anti-immunoglobulin G [IgG] and immunoglobulin M [IgM] T. gondii antibodies positivity were found to be 195 [76.5%] of the 255 hemodialysis patients and 24 [48%] of the 50 control subjects. The difference between them was statistically significant [p<0.05]. In addition, an increase of the seropositivity rate was detected with increasing length of time on hemodialysis treatment, indicating a statistically significant difference between these 2 parameters [p<0.05]. These findings confirm a high prevalence of toxoplasma infection in hemodialysis patients. These patients are a risk group for toxoplasma infection. Moreover, it is recommended that hemodialysis patients who are susceptible to toxoplasma infections should be identified by T. gondii IgG and IgM specific serological tests. Therefore, patients undergoing hemodialysis should be screened for toxoplasma before dialysis to prevent the dissemination of this infection through the hemodialysis procedure

Continuous ambulatory peritoneal dialysis improves both the number and memory function of CD4 T cells in uremic patients.

Cell-mediated immune response (CMIR) was studied in 16 ESRD (end-stage renal disease) patients prior to and after 6 months of treatment with CAPD (continuous ambulatory peritoneal dialysis). Quantitative assessment of the CMI system showed that the mean values of number and percentage of total lymphocyte count, CD4, CD8, and CD4/CD8 in ESRD patients were lower than in the normal population. Such values, however, were significantly increased after 6 months of CAPD treatment. To determine qualitative function of the CMI system, both in vitro (PHA stimulation test) and in vivo (multi CMI skin test) tests were examined. There were no significant changes in the results of PHA stimulation test after 6 months of CAPD treatment. In multi CMI skin test, the number of patients converting from negative to positive result was obviously noted following CAPD therapy for 6 months. In conclusion, both quantitative and qualitative CMI impairment existing in ESRD patients could be corrected, although not completely, by 6-month CAPD treatment.

Immune response of intradermal hepatitis B vaccination at lower dose versus intramuscular vaccination at double standard dose in predialytic chronic renal failure patients.

The immune responses to hepatitis B vaccine were studied in 2 groups of predialytic chronic renal failure patients who had negative results of hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs) and hepatitis B core antibody (anti HBc). In the intradermal group, vaccine at the dose of 0.1 ml, 2 microg, was intradermally administered at 5 positions. In the intramuscular group, the vaccine at the dose of 1.0 ml, 20 microg, was intramuscularly given at 2 positions and, thus, was a double standard dose. Both groups received 4 vaccinations at month 0, 1, 2, and 6 (M0, M1, M2, and M6). The results showed that there were no significant differences in the results of seroconversion rates, defined as having anti HBs levels above 10 mIU/ml, between the intradermal (ID) and intramuscular (IM) groups at M1, M2, M6, and M7. In patients with positive seroconversion results at M7, the numbers of patients in the good and excellent subgroups, having HBs Ab levels ranged 10-999 and above 1,000 mIU/ml respectively, showed no difference between both routes. The body weight and seroconversion rates at M2 and M6 were the factors which had a positive influence on the seroconversion rates of intradermal hepatitis B vaccination. In conclusion, intradermal hepatitis B vaccination at a lower dose could provide comparable satisfactory immune response with the intramuscular route at double the standard dose.

Anti-Heparin-Platelet Factor 4 Antibody is a Risk Factor for Vascular Access Obstruction in Patients Undergoing Hemodialysis

Since heparin is an anticoagulant commonly used in hemodialysis and the patients on hemodialysis are repeatedly exposed to heparin, heparin may be the cause of the development of heparin-dependent antibodies and thrombotic complications in patients on hemodialysis. The purpose of this study was to determine the prevalence and the clinical significance of the antibodies against heparin-platelet factor 4 complexes as determined by enzyme immunoassay in patients on maintenance hemodialysis. The prevalence of anti-heparin-platelet factor 4 antibodies was higher in hemodialysis patients than in normal subjects (8.8 vs 0.0%, p<0.05). The number of past episodes of vascular access obstruction per year was significantly higher in the anti-heparin-platelet factor 4 antibody positive group than antibody negative group. Anti-heparin-platelet factor 4 antibody positive patients experienced more frequent vascular access obstructions than control subjects. In conclusion, anti-heparin-platelet factor 4 antibody might be a risk factor for vascular access obstructions in patients with end-stage renal disease on maintenance hemodialysis.

Anti-Toxoplasma gondii Antibodies in Haemodialysis Patients with Chronic Renal Failure

This study aimed to determine the prevalence of anti- Toxoplasma gondii antibodies in haemodialysis patients with chronic renal failure (CRF). Methods: One hundred and seventy three haemodialysis patients, and 40 healthy controls, were studied for the prevalence of anti-Toxoplasma gondii antibodies by a micro enzyme-linked immunosorbent assay (ELISA). Anti-T. gondii IgG antibodies were detected in 97 (56.06%) haemodialysis patients and 8 (20%) controls with a statistical significance. In addition, anti-T. gondii IgM antibodies were detected in 1.73% of patients, but none of the controls. In conclusion, a high percentage of positivity for Toxoplasma antibodies in patients with CRF undergoing haemodialysis was noticed, thus parasitological surveys of CRF patients should be periodically performed to prevent the possible dissemination of toxoplasmosis through the dialysis procedure.

Hepatitis and HIV infection during haemodialysis.

Viral hepatitis and human immunodeficiency virus (HIV) infection are important causes of mortality and morbidity in patients treated by haemodialysis (HD). Both are further promoted by the characteristic immunological dysfunction that develops in renal failure and interferes with the patient's ability to eliminate these viruses. The hepatotropic viruses A through G remain the causative agents in 60 to 80% of hepatitis. But, as far as HD is concerned, hepatitis B virus (HBV) and hepatitis C virus (HCV) are the two most important organisms responsible for almost all the patients' morbidity. In HD, both patients as well as staff are at a high risk of acquiring hepatitis B infection. The prevalence of HBV in the dialysis population in India is reported to range between 3.4% and 42%. The acute course of the infection is often anicteric and peak transaminase concentration is significantly less than in patients with normal renal function. Up to 60% of dialysis patients with HBV infection develop chronic hepatitis with persistence of hepatitis B surface antigen (HBsAg) and infectivity. The risk of transmission of HBV infection due to blood from one patient to another is mostly because of inadequate precautions taken by the dialysis staff. Combined therapy with interferon (6-10 million units) three times a week and lamivudine (100-300 mg/day) would be more effective in controlling viral replication. The most important modality for prevention of HBV infection is induction of immunity by hepatitis B vaccination. Administration of 40 microg doses at months 0, 1, 2 and 6 is the most rapid immunogenic schedule. The prevalence of HCV in HD patients ranges from 6% in the United Kingdom to 60% in Poland and Eastern Europe, 8-36% in North America. HD patients in different parts of India exhibit high anti-HCV positivity (12.1%, 45.2%, 33.3% and 41.9%) in various studies. The incidence and prevalence of HCV infection among patients on dialysis in developed countries are steadily declining because of (i) reduction in post-transfusion HCV infection, (ii) infection control measures to prevent nosocomial infection. Among HD patients with HCV infection, serum alanine aminotransferase (ALT, SGPT) levels are elevated in only 4 to 67% patients who are positive for anti-HCV, in only 12 to 31% patients with HCV RNA and only in one-third of those with biopsy proven hepatitis. Number of blood transfusion, duration of HD treatment, and mode of dialysis are important risk factors. Patient to patient transmission of HCV occurs in HD units by needle stick injury, breakdown in standard infection control practices, physical proximity to an infected patient, dialysis machines, dialysis membranes and HD ultrafiltrate and reprocessing of dialyser. The prevalence of HIV infection in dialysis populations varies according to different countries and geographic areas, 0% and 13% in 1990 and 1995 respectively. There was no evidence of transmission within the centre transmission, from patient to patient or patient to staff. Antiretroviral therapy is the corner-stone of the HIV infection in end stage renal disease (ESRD). Most commonly, zidovudine (AZT) has been used in these patients. Currently recommended dose of 200 mg three times a day is probably safe in these patients.

Effect of granulocyte macrophage colony stimulating factor on hepatitis-B vaccination in haemodialysis patients.

OBJECTIVES: Haemodialysis patients often fail to respond to hepatitis B vaccination. There are various agents that can be used as vaccine adjuvant in chronic renal failure patients on haemodialysis. In this study, the adjuvant effect of granulocyte macrophage colony stimulating factor (GMCSF) is compared with that of control subjects. METHODS: In this study, eight patients were started on 150 mcg of GMCSF subcutaneously 24 hours prior to intramuscular hepatitis B vaccination (20 mcg of genetically engineered vaccine at the same site). The antibody response to surface antigen (anti HBsAg) in these patients were compared with those of eight control subjects who received standard three doses of monthly 40 mcg of same hepatitis B vaccine. RESULTS: In the control study, only two patients developed significant antibody response to surface antigen whereas seven of eight patients in GMCSF group developed significant antibody titres (> 10 IU/L). The sero-protection rate was 87.5% in GMCSF group and 25% in control group. CONCLUSION: This study shows that GMCSF offers significantly better seroprotection against hepatitis B compared to standard dose of vaccination in patients with chronic renal failure on haemodialysis.

Prevalence of anti-HCV antibodies in central India.

The study group screened for anti-HCV comprised 789 subjects of hepatitis, renal failure, thalassaemia and healthy voluntary blood donors coming from Central India during July 1992 to November 1995. The prevalence of HCV was low (4.85%) among 103 patients of acute viral hepatitis (AVH) while it was higher (25.64%) among 117 patients of chronic liver disease (CLD) with the highest rate of 31.57 percent in 57 patients of cirrhosis. The anti-HCV positivity among 101 patients with hepatic failure was around 10 percent. High risk groups such as chronic renal failure (CRF) patients mainly on haemodialysis and thalassaemics receiving multiple blood transfusions showed the prevalence of anti-HCV in 41.9 and 25.45 percent respectively. Only 1.78 percent of the 280 voluntary blood donors showed positivity for anti-HCV. Comparison of the data on HCV in the present study with data from other parts of India showed a wide variation in the different centers. The higher prevalence of HCV among CRF patients and thalassaemics indicates the need for screening of the blood units for anti-HCV before transfusion to these high risk patients.

Defective lymphoproliferative responses & interleukin-2 production in chronic renal failure patients.

Cellular immune responses were evaluated in 12 early renal failure (ERF) patients who were not on maintenance haemodialysis, 43 end stage renal disease (ESRD) patients on haemodialysis (HD) and 25 healthy volunteers. Peripheral blood mononuclear cells (PBMC) of ERF and ESRD patients on HD had a significantly diminished lymphoproliferative responses to phytohaemagglutinin and a monoclonal antibody to the CD3 (anti-CD3) receptor on T-cells as compared to normals. The interleukin-2 (IL-2) production by the PBMC was also significantly reduced in renal failure patients as compared to normals. These data suggest that both IL-2 dependent and IL-2 independent T-cell functions are defective in renal failure patients.

Incidence of hepatitis C virus [HCV] antibodies among haemodialysis patients and staff members

50 patients with chronic renal failure on maintenance hemodialysis, 25 staff members dealing with these patients, and 15 control subjects were examined for anti-HCV using a second generation ELISA test. The incidence was 56% among on hemodialysis program, and 8% for the staff members, while it was nil among healthy subjects 14. 28% of the positive HCV were concurrent carriers of HBs Ag as compared to 4. 58% HBs Ag carriers among HCV negative subjects. We found no significant association between anti-HCV positivity and whether the patients had blood transfusion or not. The incidence of anti-HCV in hemodialysis patients increased with the duration' of dialysis and with the volume of blood transfusion. So, it is recommended to instruct blood banks to add anti-HCV [second generation] testing to their essential tests. Also, every patient undergoing hemodialysis must be examined for anti-HCV and positive cases should be isolated to be dialysed in a separate machine. staff members of dialysis units should be a separate staff, and examined periodically to detect any anti-HCV positive cases

Cellular and humoral immunological changes in chronic renal failure associated with schistosomiasis

The changes that occur in cell mediated and humoral immunity in patients suffering from chronic renal failure associated with schistosomiasis were studied. There was a decrease in T3%, T4% and T4/T8 ratio. IgG, IgM and IgE levels were found to increase in such cases. It was concluded that there was a reciprocal relationship between cell mediated immunity and IgE levels in cases with chronic renal failure associated with bilharzial hepatosplenomegaly