pattern of dyslipoproteinemia in non- dialyzed chronic renal failure patients

Dyslipidemia is a common finding among patients with chronic renal failure [CRF] Lipid abnormality in CRF is a risk factor for atherosclerosis which is one of the leading causes of death in uremia. In biochemical lipid studies, the absolute and relative Concentrations of individual fractions of circulating triglyceride and cholesterol in different lipoprotein classes are more significant than their serum total levels. However, such studies are obviously rare. The aim of this study was to determine plasma triglyceride and cholesterol contents of VLDL. LDL and HDL classes in patients with chronic renal failure [not yet undergoine dialysis] due to chronic renal disease and to compare the data with their similar results in matched normal subjects. Twenty five male patients with chronic renal disease and CRF were recruited from Mansoura University Hospitals. Also twelve healthy male subjects matched for age and body weight were simultaneously investigated as a normal control After 12 hr overnight fast, blood samples were drawn into EDTA tubes and plasma were separated. Different plasma lipoproteins were layered by high performance density gradient ultracentrifugation. This was followed by measurement of triglyceride and cholesterol fractions in the different lipoprotein layers by the respective enzymatic-colon metric method. There were significant increases in plasma VLDL-TG, LDL-TG and HDL-TG values in CRF above the corresponding normal values. This induced significantly higher than normal circulating TG concentrations. At the same time, there were significantly lower LDL-C and HDL-C concentrations and significantly higher VLDL-C mean value in uremic patients than the corresponding value in the control. The sum of the different lipoproteins cholesterol concentrations gave insignificant change in total serum cholesterol concentration in CRF patients in comparison to normal control. All lipoproteins participate in carrying the excess triglyceride. Cholesterol bounds to lipoproteins was subnormal as regard LDL and HDL but higher than normal with VLDL. HypertrigIyceridemia enhances atherosclerosis of cerebral and/or coronary arteries in CRF

Significance of circulating levels of N-Terminal pro-brain natriuretic peptide and cyclic guanosine monophosphate as prognostic markers of congestive heart failure

Brain natriuretic peptide [BNP] represents a new biochemical marker for left ventricular systolic dysfunction [LVSD], especially the amino terminal fragment of its prohormone; NT-proBNP. In this study, plasma levels of NT-proBNP, as well as its second messenger cyclic guanosine monophosphate [cGMP], were evaluated for their diagnostic and prognostic potential and their impact on treatment strategies in patients with congestive heart failure [CHF]. Patients and Eighty patients with CHF [Class II-III] were included in the study in addition to ten healthy subjects [control group]. Ten of the patients were treated with standard therapy [ST] of digoxin and furosemide. Other patients were receiving one or more of the following treatments in addition to the ST; angiotensin-converting enzyme inhibitor [captopril], aldosterone antagonist [spironolactone] and vasodilator [isosorbide dinitrate]. Plasma level of NT-proBNP showed a highly significant increase in all CHF patients with LVSD, compared to normal controls. Poor prognosis was obtained in patients treated with ST alone assuming insufficient effect of ST to improve cardiac remodeling. Treatment with either captopril or spironolactone, together with ST, were nearly equally effective in ameliorating LVSD, as reflected by the significant decrease in NT-proBNP, compared to ST alone. The combination of captopril with spironolactone and/or isosorbide dinitrate exhibited a more powerful effect in lowering NT-proBNP, indicating relief of the ventricular overload in CHF patients. The vasodilator isosorbide dinitrate was one of the most promising drugs in improving cardiac function and reducing NT-proBNP and hence improving prognosis. Cyclic GMP showed no correlation with plasma NT-proBNP, although it was significantly increased in patients treated with isosorbide dinitrate in combination with captopril and spironolactone, compared to ST group. Moreover, plasma NT-proBNP showed no correlation with the ejection fraction, the measurable value of echocardiography. These results suggest the use of NT-proBNP as a prognostic marker in development of strategies of therapy for CHF. However, the link between neurohormonal activation and homodynamic approaches requires further investigations