Impact of renal functional impairment on serum tumor markers levels

The objective of this work was to study the impact of renal functional impairment on the circulating levels of alpha-fetoprotein [AFP], carcinoembryonic antigen [CEA], and cancer antigen 19-9 [CA-19-9]. Fifty-one subjects were enrolled in this study. They were divided into three groups. The first group consisted of 13 apparently healthy volunteers [five males and eight females] as a control group. The second group included 17 patients with end stage renal failure [ESRF] [eight males and nine females]. The third group comprised 21 patients [12 males and nine females] with ESRF maintained on hemodialysis [HD]. Tumor marker determinations were performed using enzyme-linked immunosorbent assay. Data management and analysis were performed using Statistical Analysis Systems. Data were summarized using means and standard deviations. Comparisons between groups were done using Kruskall-Wallis, nonparametric analysis of variance. To measure the strength of the association between two numeric variables, Pearson's correlation coefficient was computed. All p-values are two-sided. P-values <0.05 were considered significant. The results suggested that renal functional impairment should be added to the list of benign conditions associated with high serum CEA and CA-l9-9 levels. Before interpreting a tumor marker result in a patient with compromised renal function, it was showed that renal impairment might induce a misleading tumor marker elevation. The lack of significant correlation between elevated serum tumor marker values and serum creatinine and/or urea, and the observed normal serum AFP values raises many questions about the exact mechanisms responsible for increased some tumor markers levels in uremia. The recorded conflicting results of serum tumor markers in uremia indicated that the study of tumor marker kinetics in uremic patients deserves a more considerable attention

Study of the interaction between insulin, insulin-like growth factor-1 [IGF-1] and sympathetic nervous system in patients with hepatorenal syndrome

The current study was conducted to understand the interactions between the sympathetic nervous system [SNS], insulin and IGF-1 in cirrhotic patients with renal impairment. This study included 42 patients with cirrhosis [14 cases without ascites, 16 with ascites and 12 with HRS] and 13 healthy subjects as a control group. Enzyme immunoassay technique was used for measurement of serum insulin, serum IGF-1 plasma noradrenaline and plasma neuropeptide Y [NPY]. The results suggested that low circulating IGF-1 might contribute to renal functional impairment in cirrhotic patients. Further studies are necessary to evaluate whether IGF-1 can become a useful therapeutic agent in patients with liver cirrhosis and HRS. Progressive impairment in systemic hemodynamics in cirrhotic patients might underlie a detective sympathetic response which deserves intensive research studies