Lower gastrointestinal bleeding in patients with end stage renal disease in Assiut University Hospitals

To evaluate the association of lower gastrointestinal bleeding [LGIB] with patients of end stage renal disease [ESRD] maintained on regular hemodialysis, the present study was designed on a prospective basis, it was carried out on 60 patients of ESRD 36 males [60%], 24 females [40%] complaining of lower gastrointestinal bleeding in a different variety with a mean age +/- SD of 40 +/- 10 years and another 20 patients of ESRD with no gastrointestinal bleeding regarding occult blood in stools as a control group, all were diagnosed at the Nephrology Unit of Assiut University Hospitals through the year 2006. The Patients and control were divided into three groups:- [A] 20 patients of ESRD [12 males and 8 females] having marked pallor, iron deficiency anemia with faecal occult blood positivity. [B] 20 patients of ESRD [11 males and 9 females] who have chronic intermittent hematochezia. [C] 20 patients of ESRD [13 males and 7 females] suffering acute severe hematochezia. [D] Another 20 patients of ESRD [11 males and 9 females] with no lower gastrointestinal bleeding as a control group. All patients in group A, B, C were subjected to upper and lower gastrointestinal endoscopy, groups A and controls were subjected to stool occult blood estimation using slide test [hema screen test]. The studied groups showed the following results: [1] 31 cases [51.7%] of ESRD patients with LGIB had angiodysplastic lesions of the colon, while the other 29 cases of [48.3%] had upper gastrointestinal lesions. [2] Upper gastrointestinal lesions may be massive enough to cause LGIB. [3] Quality and quantity of LGIB showed significant difference with duration of dialysis: Patients presented with acute severe haematochezia showed duration of dialysis longer than those of moderate intermittent one and patients presented with positive faecal occult blood showed duration longer than the other two groups. The duration of dialysis in patients having angiodysplasia of the colon was significantly longer than control group. On the other hand, patients of control group had underwent duration of dialysis longer than group B and they did not show any gastrointestinal bleeding, this may mean that long duration of dialysis alone is not a definite cause of the bleeding. [4] 32 patients [53, 3%] of studied groups had inefficient dialysis, while 28 [46.7%] patients had efficient dialysis. The dialysis in 23 cases of 31 patients of ESRD with angiodysplasia was also inefficient dialysis, while the other 8 cases were on efficient dialysis. So, inefficient dialysis may contribute to the occurrence of LGIB, but it is not the only definitive cause for this bleeding. It could be concluded that: [I] middle aged males were more liable to LGIB than middle I aged females; [2] Angiodysplasia of the colon was the most common cause of LGIB in our studied groups, but upper gastrointestinal tract lesions should also be considered. [3] Long term duration of dialysis may share in the occurrence of LGIB. [4] Inefficient dialysis may have a role in the occurrence of this bleeding. We can recommend that patients of ESRD presenting with severe microcytic hypochromic anemia should be examined for faecal occult blood aiming at early detection of angiodysplasia of the colon

Role of some mycotoxins in inducing kidney diseases in upper Egypt

Egypt has a climate that favors the growth of fungi specially those producing mycotoxins. Mycotoxins are found all over the world in human food and blood as well as in animal blood and tissues. The most threatening effects are their nephrotoxicity and carcinogenicity. The aim of this study was to identify the role of some mycotoxins namely; ochraloxin A [OTA] and fumonisin B[1] [FB1] in the occurrence of chronic renal disease of unknown aetiology in Upper Egypt. This study was carried out on 134 subjects who were classified as: 47 patients suffered from chronic renal failure of unknown aetiology before dialysis treatment [group A], 35 subjects who were relatives of patients in group A considering that they share them in the same environmental conditions [group B], 28 subjects working in the Middle Egypt Company [MEC] for grinding of cereals as an occupational risk group for exposure to inhalation of mycotoxins [group C] and 24 subjects with normal kidney functions as a control group. They exposed to a detailed history, their occupation, family history and kidney function tests. Indices of early kidney affection and levels of OTA and FB[1] in urine and serum for all subjects in all groups were also done. As regard group A, OTA was significantly increased while FBI was non-significantly increased in both serum and urine of patients compared to control group. There was positive correlation between the levels of OTA in both serum and urine versus the level of blood urea. It was found also that the patients with positive ochratoxicity had mild proteinuria. As regard group B, OTA and FB[1] were detected in urine and plasma, although with levels lower than that in group A but significantly higher than that of controls. As regard group C, OTA was found to be nearly equal to that in controls both in serum and urine which may indicate the low contamination levels of cereals in MEC due to good storage conditions. However, FB[1] was found in serum to be insignificantly higher than that in groups A and controls. Also FB[1] was detected in urine insignificantly lower than that in group A and insignificantly higher than that in controls. Although the results were statistically non significant but may indicate the increased risk of exposure to FB[1] in this group. We concluded that the presence of OTA and FB[1] in serum and urine of our control group may indicate the presence of these two mycotoxins as contaminants in the food in our locality. Also, these toxins may play a role in inducing chronic renal diseases in our locality. We advise a continuous follow up for all subjects exposed to these toxins, giving instructions about ways for protection and treatment as well as good storage for cereals and foods

Comparative study between two methods for detecting cytomegalovirus in chronic renal failure patients

This work was- designed to evaluate and compare Human Cytomegalovirus [HCMV] ELISA and Polymerase chain reaction PCR methods for the detection of HCMV in chronic renal failure patients. Also, it aims to correlate HCMV infection with positive clinical history, duration of dialysis, blood transfusion and renal transplantation. The present study was conducted on 66 patients with chronic renal failure, divided into two subgroups [50 non-transplanted on hemodialysis and 16 renal transplanted patients], and twenty apparently healthy volunteers as control group. Both the patients and the controls have been studied for detection of HCMV infection by CMV specific IgG and IgM ELISA assay, and qualitative leukocytes PCR assay. Regarding CMV IgG and IgM were detected in 66 [100%] and 10 [15.1%] patients respectively. The patients' group was found to be positive for CMV IgM and PCR assays in a percentage of 15.1% and 45.4% respectively with statistically significant difference compared to the control group. By PCR, HCMV positivity was significantly increased more frequent among non-transplanted patients with frequent blood transfusion. However, frequent blood transfusion had no influence on the positivity of HCMV in renal transplanted patients. Also, duration of dialysis In non-transplanted patients had insignificant role on the positivity of HCMV. Although the positivity for CMV IgM ELISA was [12%] and [25%] among non-transplanted and transplanted subgroups respectively, the difference was statistically insignificant. Comparing the positivity for PCR which was [42%] and [56.25%] among non-transplanted and transplanted subgroups respectively, the difference was also statistically insignificant. The relative sensitivity and specificity of CMV IgM ELISA assay compared to CMV PCR were 30% and 97.2% respectively. We concluded that leukocytes PCR is a reliable test in screening HCMV infection and it is more valuable than serology in diagnosis of HCMV infection. Also, the determination of IgM antibodies for HCMV is not helpful in identifying patients at risk or in following the course of HCMV disease because antibody response is too slow and it has low sensitivity

Comparative prospective study of various endoscopic treatments for different grades of escophageal variceal bleeding in Upper Egypt

This study was performed on 120 patients presented with liver cirrhosis and active variceal bleeding in the form of hematemesis or melena or both in Assiut University Hospital. They were 79 male and 41 female aging from 25-70 years. All patients were chosen to be Child-Pugh class B. All patients included in this study were subjected to upper gastrointestinal endoscopy, and one of the following was done to the bleeding esophageal varices: Sclerotherapy with Ethanolamine [Group A,], Sclerotherapy with Histoacryl [Group B], Band ligation, [Group C] and combined scleroligation [Group D] and the varices are classified according to Westaby classification 1982 into grade I, II, III and IV We also follow up endoscopy until obliteration of varices was achieved. The present study was undertaken to compare the different endosco-pic techniques used in active esophageal variceal bleeding, and its efficacy in controlling bleeding from the varices, the rate of rebleeding, the number of sessions done to obliterate the varices, and the complication in the form of esophageal ulceration. From this study, it was suggested that the choice of endoscopic technique used Jar management of bleeding esophageal varices depends on the grade of varices as follow: In Grade II esophageal varices with active bleeding, there was no method of choice, but it is better to start with Ethanolamine injection for control of bleeding ['because it is available easy and cheap technique]. If failed so Histoacryl injection should better second choice. In Grades III and IV esophageal varices with active bleeding, it is better to start with band ligation for the control of bleeding, it ii the method of choice, as i has better control, of bleeding, the least number of sessions, the least rebleeding rate, with no complications and the easiest method of treatment. We also found histoactyl injection although it is the best method of controlling bleeding, it is better to use it only f the other methods are not effective, as it is a very expensive method and used only in the first session or in rebleeding It is hazardous in small varices if not cautiously administered and we also found that scleroligation did not add any benefit over band ligation but more adverse effects and complications were noticed. In conclusion, band ligation was the method of choice for esophageal variceal obliteration among all the other endoscopic techniques as regard all the variables collectively, also we could decrease the cost of band ligation to a minimum degree

Searching for the aetiology of chronic renal impairment in patients attending nephrology out-patient clinic of Assiut University Hospital

Seventy-two patients with various medical causes of chronic renal impairment were included in this study. They were subjected to thorough clinical examination and laboratory, imaging and histopathological evaluation. Primary glomerulonephritis was found in one third of the patients, while secondary renal diseases were found in the other two thirds. Schistosomiasis, HCV infection, diabetes mellitus, polycystic kidney disease, hypertension and lupus nephritis were found to be the main causes for secondary renal diseases

Evaluation of renal function in acute cerebrovascular stroke

In this study, renal function was evaluated for 30 patients with acute cerebrovascular stroke [21 with cerebral infarction and 19 with cerebral hemorrhage] on admission, days 4 and 8 after stroke onset and in 50 healthy sex and age matched volunteers. In spite of the exclusion of most of the known risk factors of renal function deterioration, a statistically significant elevation of serum urea and creatinine as well as a reduction of creatinine clearance were observed throughout the study period in the patients group compared with the controls. Patients with cerebrovascular stroke whether cerebral hemorrhage or infarction exhibit a deterioration of their renal function in the acute phase of their illness