Y chromosome microchimerism in patients with systemic lupus erythematosus

To identify the association of Y chromosome microchimerism with systemic lupus erythematosus [SLE] and investigate its relation to pregnancy history, clinical and laboratory variables. The presence of Y chromosome microchimerism was screened in 90 females including 35 women with renal lupus, 25 patients with cutaneous lupus and 30 healthy control females using real time polymerase chain reaction. Demographic parameters, reproductive history, clinical and laboratory data were recorded. The percentage of Y chromosome microchimerism was significantly higher in SLE patients compared to healthy women and in females with renal lupus versus those with cutaneous lupus. Among patients with renal lupus, Y chromosome microchimerism was strongly associated with disease activity and damage indices as well as with number of pregnancies, while this association was absent regarding number of pregnancies in cutaneous lupus females. A significant increase in disease activity and severity scores was detected in microchimeric renal lupus females when compared to microchimeric cutaneous lupus patients. Healthy control and cutaneous lupus women with microchimerism experienced significant decrease in number of pregnancies and abortions against microchimeric renal lupus group. These results may provide a preliminary suggestion that Y chromosome microchimerism could have a pathogenic role in SLE and it may be related to inflammation, the extent of disease damage and reproductive history. Further studies are needed among SLE patients with different clinical presentations, as fetal microchimerism is a promising field of investigation which may lead to novel strategies in treatment

Non-invasive diagnosis to predict adynamic bone disease in haemodialysed patients

Precise evaluation of the underlying type of bone disease in hemodialysed patients frequently requires bone histomorphometry [including static and kinetic variables after double tetracycline labeling], which is an invasive and costly method. Due to the prevalence of Adynamic bone disease in hemodialysis patients, different biochemical noninvasive markers such as [serum intact osteocalcin, serum intact parathyroid hormone [iPTH] and bone specific alkaline phosphatase [bAP] have been shown to be helpful in differentiation between low and high bone turnover. Our study was conducted to detect the usefulness of measuring serum intact osteocalcin and its correlation with serum iPTH and bAP to distinguish Adynamic bone disease from other forms of renal osteodystrophy in hemodialysed patients. The study included 60 patients and 20 normal control subjects, presented at renal dialysis units, Ain Shams University hospitals. The hemodialysed patients were classified according to the results serum iPTH and bAP into two groups: Group I: Included 18 patients [30%] with serum iPTH level £150 pg/ml and serum bAP >/= 27 ng/ml. Group II: Included 42 patients [70%] with serum iPTH level > 150 pg/ml and serum bAP > 27 ng/ml. The serum level of intact osteocalcin was measured for the control group and for all hemodialysed patients. The results revealed highly significant statically differences in serum level of intact osteocalcin between all patients group and the control subjects being lower in control group. Also, the results revealed that 30% of all patients group had Adynamic bone disease and comparison between serum level of intact osteocalcin in Adynamic bone disease group versus other patients group was highly significant, being higher in other patients group. There was no significant difference between Adynamic bone disease patients and other patients as regard serum phosphorus, and serum calcium but there was a significant difference as regard age, while highly significant difference as regard sex, duration of hemodialysis, serum intact osteocalcin, iPTH and bAP. These results suggest that combined estimation of serum iPTH, serum intact osteocalcin, and bAP can provide a useful information on the bone status in uremic patients and represent reliable noninvasive diagnostic tools for the prediction of Adynamic bone disease

Effect of haemodialysis on intra dialytic calcium, phosphorus, magnesium, levels in relation to autonomic nervous system activity

Autonomic nervous system dysfunction is common in uremia and in patients under hemodialysis. Changes in serum calcium, serum phosphorus and serum magnesuim always occur during hemodialysis. The relation between these changes and autonomic nervous system activity during hemodialysis has not been fully studied. This study was carried out on 30 patients with chronic renal failure on regular hemo- dialysis with nearly similar age group. We measured serum calcium, serum phosphorus and serum magnesium throughout the session [at predialysis state, middialysis state: after 2 hours of the session and postdialysis: at the end of the hemodialysis Session]. We have also assessed autonomic function [sympathetic by cold pressor test and parasympathetic by Valsalva maneuver test]. Autonomic function tests were assessed at predialysis state, middialysis state and postdialysis state. Calcuim level uncreased throughout the session [P<0.05], phosphorus leuel and Magnesium levels decreased, [P<0.001] and [P<0.05], throghout session . As reguards parasympathetie dysfunetion, there was a significamt relation [P<0.05] with calcuim changes at predialytic and post dialytic states, a highly significant relation [P<0.001] with phosphorus and [P<0.05] with magnesiun, both at predialysis states. Concerging sympathetie dysfunction, there was a significant relation [P<0.05] with calcium levels at end of session. There was a signifcant relation [P<0.05] with predialytic and postdialytic phosphorus levels .There was also significant relation [P<0.05] with predialytic magnesium level