Sirolimus based therapy in live donor renal transplantation: a prospective randomized study

The present work aimed to study safety and efficacy of sirolimus in combination with either low dose tacrolimus or mycophenolate mofetil in live donor kidney transplant recipients. A total of 80 patients of either sex aging >/18 years with end-stage renal disease who had undergone live donor renal allotransplantation were recruited into the study. They were randomly divided into two groups. Group A patients received sirolimus in dose of 10 mg/day for 3 days after surgery then maintained on 5 mg/day. In addition, they received tacrolimus and steroids. Group B patients received sirolimus in dose of 10 mg/day, mycophenolate mofetil and steroids. All patients were followed up for 12 months clinically and by laboratory, radiologic and histopathologic evaluation. The study showed that excellent one year kidney transplant outcomes can be achieved by sirolimus administration especially with avoidance of calcineurin inhibitors. Longer follow-up is required to study the impact on graft integrity and eventual graft survival and chronic rejection rates

predictive value of C-reactive protein for some clinical and biochemical disorders in patients with chronic renal failure

The present work aimed to study the possible role of inflammatory process in the pathogenesis of anemia, malnutrition. ischemic heart disease, half and half nail sign dyslipidemia and hypoalbuminemia in patients with chronic renal failure under hemodialysis and the predictive value of C-reactive protein [CRP] in these disorders. The subjects of this work comprised of fifty patients with chronic renal failure in the Nephrology unit Benha University Hospital. They were divided into two groups including twenty patients under conservative treatment and thirty patients under regular hemodialysis treatment: 10 patients using polysulphone dialyzers and 20 patients using cuprophane dialyzers. In addition ten healthy subjects were used as controls. For all of them the following was done; full medical history, complete clinical examination, hematological parameters [Hb. content, Nt value, complete blood picture, mean corpuscular volume, mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration], biochemical tests [blood urea, serum creatinine, serum albumin, serum cholesterol and C-reactive protein] and electrocardiogram. The results showed that CRP level in chronic renal failure patients either under conservative treatment or hemodialysis was elevated [12 +/- 3.980 mg/dL and 11.73 +/- 8.081 mg/dL respectively] as compared to the control group [1.85 +/- 1.1 mg/dL] and p<0.05. There was no significant difference between group with conservative treatment and group with hemodialysis [p>0.05]. CRP level was higher in patients using cuprophane dialyzers than patients using polysulphone dialyzers [14.7 +/- 8.3 mg/dl vs 5.8 +/- 2.3 mg/dL] and p<0.05. Hemoglobin concentration was statistically insignificant between patients dialyzed by euprophane or polysulphone [mean value 8.3 +/- 2.6 gm/dl vs 9.9 +/- 2.6 gm/dl, p>0.05]. CRP level was negatively correlated with serum albumin level in CRF under hemodialysis patients [r=0.409 and p<0.05]. Serum albumin level was significantly higher in patients dialyzed by polysulphone than those dialyzed by cuprophane [mean value 4.11 +/- 0.66 gm/dl vs 3.33 +/- 0.89 gm/dl, p<0.05]. CRP level was not correlated with occurrence of half and half nail sign in hemodialysis patients [r=0.25, p>0.05]. CRP level was not correlated with serum total cholesterol level in hemodialysis patients [r=0.13221, p>0.05] while there was high incidence of ischemic ECG changes in those patients. High CRP levels were associated with by and low body mass index in hemodialysis patients, this signifies that inflammatory process contributes in occurrence of malnutrition in hemodialysis patients. Thus we have concluded that, inflammatory process contributes to anaemia, malnutrition, ischemic heart disease and hypoalbuminemia in hemodialysis patients a: C-reactive protein can predict these disorders. The use of biocompatable membranes for dialysis leads to less inflammatory process and consequently better nutrition. state of the patients

Early detection of radio contrast media induced nephropathy

Radio contrast media [RCM] induced nephropathy has been defined as an acute impairment of renal function following exposure to radiographic contrast materials after excluding other causes of renal impairment [Bersketh and Kjellstrand, 1984]. The aim of the present work is early detection of asymptomatic radio-contrast media associated nephrnpathy and its possible effect on glomerular-and tubular functions. The study included 35 subjects divided into two groups: Group I: 20 patients received RCM urographin l ml/kg body weight and Group II: 15 healthy persons as normal control who received normal saline as a placebo. Both groups were subjected to thorough clinical examination and the following laboratory investigations: urinary microalbuminuria before as well as 24 hours after RCM to test glomerular function urinary alkaline phosphatase before RCM administration as well as 5 hours. 24 hours as well as 5 days after as a test for tubular function. The results of the present study showed significant increase in microalbuminuria in group I patients after administration of RCM, also there was statistically significant increase in the mean values of urinary alkaline phosphatase observed 5 hours. 24 hours, and 5 days after RCM

endogenous antioxidant enzymes in end-stage renal disease

This study was done to evaluate the plasma endogenous antioxidant enzymes activity [glutathione peroxidase, catalase and superoxide dismutase] in patients with end stage renal disease. Sixty patients were studied. They were divided into two groups: group I [30 patients with chronic renal failure on maintenance hemodialysis] and group II [30 patients with different degrees of renal impairment on conservative drug managemen]. Thirty healthy volunteers with normal kidney function were taken as a control group [group III]. For all of them the following was done: full medical history, complete clinical examination, hemoglobin concentration and hematocrit value, serum urea, creatinine, uric acid, calcium, phosphorus, fasting and 2 hours postpr and ial blood sugar, creatinine clearance, and blood levels of super-oxide dismutase, glutathione peroxidase and catalase. We found that the blood level of superoixde dismutase was significantly lower in group I than group III [P. < 0.0001] and it was significantly lower in group II than group III [P < 0.0001] and there was no significant difference between group I and group II [P < 0.3720]. The blood level of glutathione peroxidase was significantly lower in group I than group III [P < 0.0001] it was significantly lower in group II than group III [P < 0.0001] and significantly lower in group I than group II [P < 0.0117]. The plasma level of catalase was significantly lower in group I than group III [P < 0.001] and it was significantly lower in group II than group III [P < 0.0165] and there was no significant difference between group I and group II [P < 0.7002]. There was positive correlation between hemoglobin concentration and whole blood superoxide dismutase [r= 0.5767-P<0.0001] and also plasma catalase [r=0.2348 P<0.05]. It can be concluded that impaired activity of endogenous antioxidant enzymes occurs early in the course of chronic renal failure and is further exacerbated by hemodialysis resulting in permenant oxidative stress that can be an important mediator contributing to the progression of renal failure and to associated complications such as anemia consequently, it may be possible to propose that some antioxidant substances may be useful for such patients