Experimental rat model of diabetic nephropathy: RAGE detection and effect of spironolactone monotherapy

The glycation process results in formation of advanced glycation end products [AGEs], which accumulate in different organs at an accelerated rate in diabetes, resulting in alteration of both structure and function. This effect is via the receptor for AGES [RAGE], which is a signaling receptor leading to profibrotic reactions. The renin angiotensin aldosterone system [RAAS] is activated in diabetic nephropathy [DN] and leads to more renal damage. This is inhibited by angiotensin converting enzyme inhibitors [ACEIs] and angiotensin receptor blockers [ARBs] and mineralocorticoid receptor blockers [MRBs]. To show the monotherapeutic effect of spironolactone in diabetic nephropathy and to detect RAGE. Diabetes was induced in rats by streptozotocin. Three weeks after,spironolactone [SPL] was given for 4 weeks. Then, control, diabetic and treated rats were sacrificed. The results of blood chemistry at the end of 4 weeks showed statistical increase in serum sodium, potassium and urea with no effect on serum creatinine or blood glucose. Kidney pathological injuries were attenuated by SPL also, RAGE deposition compared to the diabetics. The study showed RAGE deposition in the experimental DN and confirmed the beneficial effects of MRB in DN

Pegylated interferon alfa 2a and small dose ribavirin in the treatment of HCV genotype 4 in end-stage renal disease

As hepatitis C virus [HCV] infection is a major health problem in patients with end-stage renal disease [ESRD]. Explore the response rate and adverse effects of pegylated interferon and ribavirin in treating HCV genotype 4 in patients withend stage renal disease [ESRD] waiting renal transplantation. This study included 24 patients with ESRD and active HCV infection as detected by clinical, sonographic, biochemical, serological, virological and histological examination with liver biopsy. All patients were under hemodialysis with HCV antibodies positive > 6 months. Viral genotyping and both qualitative and quantitative PCR were carried out before starting therapy. Treatment was continued for 48 weeks using pegasys 135 micro g weekly and ribavirin 200 mg daily. The biochemical and virological responses were evaluated regularly during and after treatment. The sustained virological response [SVR] being evaluated 24 weeks later. The side effects were monitored throughout the treatment period. Rapid virological response [RVR] after week 4 was achieved in 11/24 [46%] patients. The sustained virological response [SVR] was achieved in 16/24 [66.7%] patients. No break through or relapses were detected during and after treatment respectively. Correlation was found between the viral load before treatment and that at week 4 with p < 0.001and at 12 weekand between the reduction of hemoglobin and the reduction of viral load at week 12 with p < 0.045. Genotype 4 HCV patients with ESRD can be considered for therapy pre-operatively to overcome all the morbidities associated with persistence of HCV after renal transplantation provided that the general condition, the hematological parameters and all other factors of treatment allowed such therapy

Study of cardic valvular calcification in ESRD patients on regular hemodialysis [a single center study]

Cardiac valve calcification are common among patients with chronic kidney disease [CKD]. Risk factors include alterations in calcium and phosphorus metabolism, elevated calcium phosphorus product and persistent elevations in plasma parathyroid hormone [PTH]. Echocardiography is a simple and inexpensive method for detection of valvular calcifications as suggested by KDIGO guidelines. 60 Patients on regular HD constituted group A [36 males and 24 females] and 25 healthy volunteers constituted group B. Group A was subdivided into: Group I: 21 patients with no valvular calcification, group 2: 26 patients with aortic valve calcification and group 3: 13 patients with aortic and mitral valve calcification. For all, the following was done: clinical examination, serum Ca, serum P, serum albumin, serum creatinine, BUN and PTH level in blood. M-mode echo cardiography was done for all. Age, duration of dialysis and duration of 1ry kidney disease was higher in group 2 and 3 compared to group 1 [p = 0.0001]. Calcium was higher in group 2 than group 1 [p = 0.09] and group 3 [p = 0.004] than group I phosphorus was higher in group 2 and 3 than group 1 [P = 0.001]. P was higher in group 3 than group 2 [p = 0.0001]. Ca x P was higher in group 2 and 3 than group 1 [p = 0.0001], in group 3 than group 2 [p = 0.01] PTH was higher in group 1 than group 2 [p = 0.06]. Cardiac dysfunction by echocardiography was least in group 1, increasing in group 2 and being highest in group 3. It was found that calcified valve groups has taken higher doses of Calcium and Vitamin D3. We have to take care on prescribing Ca and vitamin D3 to ESRD patients on regular HD

SEN virus infection in Egyptian chronic hepatitis C and haemodialysis patients

SEN virus [SENV] has been tentatively linked to transfusion-associated non A-E hepatitis. The aim of the present study was to determine the prevalence of SENV among Egyptian patients with HCV-related chronic liver disease [CLD] and haemodialysis [HD] patients and to assess the clinical effect of SENV infection on coexistent hepatitis C either in the severity or the probability of developing hepatocellular carcinoma [HCC]. Polymerase chain reaction [PCR] was used to detect SENV-D and SENV-H DNA in serum samples of 74 HCV-related CLD patients, 45 uraemic patients on maintenance HD and 28 healthy controls. SENV DNA was detected in 13.5%, 11.1%, and 7.1% of CLD, HD patients and healthy controls respectively with no significant differences between patients and control group. No statistically significant differences were demonstrated between SENV infected and non infected CLD or haemodialysis patients regarding the clinical and biochemical parameters. SENV infection was significantly higher in CLD patients with HCC [33.3%] than without [8.5%] [p<0.05]. In conclusion, SENV does not seem to be a common infection in Egyptian patients. It has no apparent influence on the severity of co-existent HCV related CLD but it could be a risk factor for developing HCC in these patients. Further studies are needed to define the aetiopathogenic role of SENV infection in HCC development