Urolithiasis in patients on chronic hemodialysis

Reports were conflicting with respects to the composition of calculi formed in patients who were kept on hemodialysis and also on the pathogenetic factors involved in their formation. This study was, therefore, conducted to investigate these debates. Patients and methods: renal calculi form 38 hemodialysis patients were subjected to morphological study with microscopic examination and constitutional analysis with infrared spectrophotometry. patients' calculi were mainly consisting of oxalo-protein calculi with > 30% calcium oxalate as a total stone content [18 patients, or 47%]. They could be a consequence to metabolic factors, such as high urinary oxalate and low urinary citrate concentration, and to iatrogenic factors, namely vitamin D3 and calcium salts supplementation. In 14 [37%] patients, calculi were made of sole proteins or in association with < 30% calcium oxalate, and were observed mainly in patients with primary glomerular disease. Aluminum-magnesium urate calculi, which may be related to aluminum overload were seen in the remaining 6 [16%] patients. metabolic and iatrogenic conditions come as the predominant factors incriminated in pathogenesis of most calculi formed by hemodialysis patients. The precise analysis of such calculi is therefore, higher recommended as it can offer useful information on pathogenesis, and hence a possible approach to their prophylaxis

Helicobacter pylori in diabetics with and without neuropathy: relation to metabolic control and gastric emptying

This work was carried out on 60 diabetic patients and 20 healthy subjects as control. For each diabetic patient and for the control, the followings were done: history and clinical examination, laboratory investigations including fasting blood sugar, post-prandial blood sugar, HBA1c, lipid profile, liver and kidney function tests. Also, assessment of autonomic functions, gastroscopy and biopsy for rapid urease test, estimation of serum gastrin and gastric scintigraphy for evaluation of gastric motility. The results were as follow: patients with autonomic neuropathy demonstrated a higher prevalence of Helicobacter pylon [HP +ve] than those without and controls. Patients with motility disorder also showed a significant higher level of HP +ve than those without and controls. Diabetic patients had a significantly higher level of serum gastrin than controls. Conclusion: H. pylon prevalence was higher in diabetics and it was higher in those with autonomic neuropathy and dysmotility. Serum gastrin was significantly higher in those H. pylon positive patients. H.pylori infection tends to cause antral gastritis or pangastritis in diabetics rather than peptic ulcer especially in those with autonomic neuropathy. Non-ulcer dyspepsia is common in diabetics. Treatment of H. pylon infection may be of great benefit for metabolic control