Faecal calprotectin: correlation with endoscopic and histological gradings of disease activity in ulcerative colitis

Calprotectin is an abundant neutrophil protein which is extremely stable in feces. It is excreted in excess amount in feces during inflammatory bowel disease. This work aimed to study the relationship between faecal calprotectin concentrations and endscopic as well as histological gradings of disease activity in patients with ulcerative colitis [UC]. This study comprised 25 patients, who were confirmed to have UC by colonscopy and histological examination of colonic biopsies, in addition to 10 apparently healthy individuals as controls. Complete blood picture, C-reactive protein [CRP], erythrocytic sedimentation rate[ESR] and stool analysis were done for all studied individuals. In addition, faecal calprotectin was measured by using enzyme-linked immunosorbant assay [ELISA]. Colonoscopy was done for patients only and the severity of inflammation was assessed macroscopically and histologically by using the standard scoring systems. Patients were divided into patients with active UC and patients with no/low disease activity. Faecal calprotectin concentration was significantly higher in patients with UC [p<0.001] than in controls. Also, its levels were significantly higher in patients with active disease than in those with no/low activity [p<0.001]. Moreover faecal calprotectin concentrations increased significantly with the progression of both endoscopic and histological gradings of disease activity. Faecal calprotectin level was significantly higher in patients with active pancolitis than in those with left sided colitis or proctitis [p=0.003]. There was a significant positive correlation between both endoscopic as well as histological gradings of disease activity and faecal calprotectin. Also, faecal calprotectin significantly correlated with extent of the disease but there was no significant correlation with the clinical activity index, hemoglobin level, platelets count, leucocytic count, CRP and ESR. At cut-off value of 110mg/l faecal calprotectin detected active UC with a sensitivity of 93.3% and a specificity of 100% with a diagnostic accuracy of 96%. It was concluded that, faecal calprotectin level could be used as a non invasive marker of disease activity in patients with UC and it has the potential to reduce the number of invasive investigations performed in these patients

Determinants of circulating soluble transferrin receptor level in chronic renal failure patiets

Anemia is a common problem in chronic renal failure [CRF] especially in patients under maintenance haemodialysis [HD] therapy. Soluble transferrin receptors [sTfR] is useful for quantitative assessment of erythropoiesis in HD patients but its specificity for detection of iron-defficient erythropoiesis in HD patients with recombinant human erythropoietin [rHuEpo] therapy is insufficient, even inconclusive and controversial. So the assessment of iron-deficient erythropoiesis is a hard task in HP patients during rHuEpo therapy. We designed this work aiming at identification of factors determining the sTfR level in CRF patients predialysis or on haemodialysis with and without rHuEpo therapy. Fifty CRF patients were studied who were divided into 3 groups:- Group I: 10 patients on conservative treatment.- Group II: 10 patients on regular HD but not on rHuEpo therapy.- Group III: 30 patients on regular HD and on rHuEpo therapy. We studied also two other groups, group IV: 10 anemic patients with normal kidney function and group V: 10 apperantly healthy control. We measured in all subjects sTfR level, s. Epo, transferrin saturation [TS%], s. ferritin, s. iron, TIBC, C-reactive protein, hypochrornic red cell percentage [HRC°/o] reticulocytic count and CBC. sTfR level was significantly raised in group III [dialysis with Epo] compared to group I [predialysis] [P < 0.01] and to group H [dialysis without Epo] [P < 0.0l]. sTfR was also significantly raised in group IV [anemic non uremic] compared to CRF groups [predialysis [P < 0.01], dialysis without Epo [P < 0.0l] and dialysis with Epo [P < 0.05]]. Haemodialysis patients with rHuEpo were stratified by less than 25. 25-75 and more than 75 percentiles of serum ferritin, by < 20 and > /= 20% of TS as well as by < 10 and > /= 10% of HRC%. The levels of sTfR in patients of lower quartile [mean +/- SD 4.9 +/- 1.5 micro g/l] was higher than those with upper quartile [mean +/- SD 2.23 +/- 0.78 micro g/l] and these with 25-75 percentile [mean +/- SD 2.48 +/- 0.69 micro g/l]. In CRF patients under dialysis with Epo there was significant positive correlation between sTfR versus basal Epo [P < 0.01], HRC% [P < 0.01], retics% [P < 0.01], Hct [P < 0.0l] and Hb [P < 0.01] but was significantly negative correlated versus TS [P < 0.01] and S.Ferritin [P < 0.01]. Multivariate regression analysis disclosed that HRC%, serum ferritin, Hct and TS% were the four independent predictors of sTfR levels and accounting for [68%] of the variability in sTfR. So, sTfR levels quantitatively reflects tile integrated effects of iron availability [HRC% and TS%], iron reserves [serum ferritin] and markers of erythropoiesis [Hct] and we conclude that sTfR levels is a good index of monitoring iron deficiency and erythropoietic activity in CRF especially those under HD therapy and receiving rHuEpo and it reflected the integrated effects of iron availability, iron reserves and erythropoietic stimulation

Potential role of thrombin-activatable fibrinolysis inhibitor [TAFI] in diabetic nephropathy and its relation to degree of albuminuria and to dialysis modality

Diabetic nephropathy has become the most prevalent cause of end-stage renal disease [ESRD] in many countries, and about one third of patients with diabetic nephropathy progress to end stage renal disease. Patients with end-stage renal disease dialyzed due to diabetic nephropathy are at higher risk of death due to cardiovascular complications than dialyzed non-diabetic patients. Hypofibrinolysis is a common finding in patients with diabetes mellitus and a risk factor for diabetic nephropathy and may play a role in the vascular complications in dialyzed diabetic patients. A new potent inhibitor of fibrinolysis, the thrombin-activatable fibrinolysis inhibitor [TAFI], has been isolated from human plasma. However, the relation between plasma TAFI level and diabetic nephropathy has not been well appraised. In the present study, we investigated the plasma levels of TAFI in 50 type 2 diabetic patients: 10 with normoalbuminuria, 10 with microalbuminuria, 10 with macroalbuminuria, 10 with ESRD on haemodialysis, and 10 with ESRD on peritoneal dialysis. Also, we assessed albumin/creatinine ratio in albumiuric patients, blood urea, serum creatinine, serum lipids, and ECG. The plasma level of TAFI in diabetic patients with macroalbuminuria was significantly higher than the level in diabetic patients with microalbuminuria [P < 0.00l], and higher in micro-albuminuric patients than in normolbuminuric patients[P < 0.00l]. Plasma TAFI level was correlated to albumin/craetinine ratio[P < 0.00l], blood urea[P < 0.00l] and serum creatinine[P < 0.00l] in patients with micro-albuminuria [non dialyzed patients]. Moreover, it was significantly higher in patients with diabetic nephropathy and on peritoneal dialysis than those on haemodialysis [P < 0.01] and it was correlated positively with triglycerides [P < 0.05] and negatively with HDL-c[P < 0.05]. These data suggest that TFAI level was increased by the progression of diabetic nephropathy as it was significantly higher in. patients reaching ESRD [haemodialysis and peritoneal dialysis groups]than in those still in the stages of micro and rnacro-albuminuria and higher in macroalbuminuric patients than in microalbuminuric patients. Also TAFI level was significantly positive correlated with tile indicators of decline in renal function [blood urea, serum creatinine, urinary albumin and urinary albumin/creatinine ratio]. So we can concluded that increased plasma level of TAFI may contribute to the pathogenesis and progression of diabetic nephropathy and may have role in tile cardiovascular complications of dialyzed diabetic patients, especially those under peritoneal dialysis