Non invasive assessment of renal failure: comparison between the different available techniques to discriminate different causes of acute renal failure [ARF] from chronic renal failure [CRF] with normal kidney size

Forty-one uremic cases presenting to the emergency of nephrology section and 10 normal control subjects [N] were assessed clinically and biochemically [serum levels of urea, creatinine, uric acid, sodium, potassium, calcium and phosphorus and estimation of FENa] by abdominal ultrasonography, color Doppler of renal arteries and static [DMSA] and dynamic [DTPA] renal scintigraphy. Clinical assessment, follow up and/or renal biopsy showed that uremic cases had ARF due to acute tubular necrosis [ATN] in 16, obstructive uropathy[OBST] in 12 and CRF in 13. ATN showed very high FENa [17.7 +/- 10.5% vs 0.69 +/- 0.19, 13.4 +/- 12.9 and 10.1 +/- 5.6 in ATN, N, OBST and CRF cases, respectively], normal DTPA perfusion with poor DTPA accumulation, flat renogram with very long T1/2 and very high resistivity indices of intrarenal arteries measured by D. OBST showed pelvic caliectasis by US, impaired DMSA uptake, impaired DTPA perfusion with fair DTPA accumulation, rising renogram during the excretory phase with very long T1/2 and very high resistivity indices of intrarenal arteries measured by D. CRF had very high resistivity indices, impaired DTPA perfusion and accumulation with poor excretion, flat renogram with very long T1/2 and very high resistivity indices of intrarenal arteries measured by D. Follow up of ATN and OBST cases showed incomplete normalization of US, D and [DTPA] renal scintigraphy in spite of clinical and chemical recovery. The study concluded that the most reliable noninvasive tool in discriminating cases presenting acutely with uremia is radioisotopic static [DMSA] and dynamic [DTPA] renal scintigraphy. Moreover, clinical, biochemical, ultrasonographic and Doppler studies are neither specific nor sensitive tools in such field. Also, the kidneys did not usually recover completely after ARE

T-cell function in long term haemodialysis patients: impact of secondary hyperparathyroidism, oral one alpha calcidol and dialysis duration

The aim of this work was to study T-lymphocyte function in relation to secondary hyperparathyroidism, oral one alpha-calcidol treatment and dialysis duration. Eighty chronic renal failure patients who were maintained on regular haemodialysis treatment for 6-144 months [CRF] and 20 normal control subjects [N] were studied. Cases known to have autoimmune diseases, other diseases, which would affect the immune system or receiving medications known to affect immunity were excluded. CRF cases were 45 males and 35 females and their age was 43.06 +/- 11.1 years, while N cases were 12 males and 8 females and their age was 35.6 +/- 9.79 years. A11 CRF cases were receiving 1-alpha-calcidol orally as 1 mug/day for at least 3 months before the study onset. CRF and N cases were clinically examined and were tested for serum urea and creatinine, serum calcium and phosphorus, serum level of intact parathormone [RIA] beside the in vitro assessment of lymphoblastoid transformation of peripheral blood lymphocytes with and without phytohaemagglutinin [PHA] stimulation. The serum level of intact parathormone varied significantly among CRF cases; it was < 40 pg/ml in 13 [CRF1], 40-80 in 14 [CRF2] and > 80 in 53 [CRF3]. Among these 3 subgroups, pre-activation of T-lymphocytes was significantly higher in CRF3 [28 +/- 3.94 vs. 33.7 +/- 5.44 vs. 37.36 +/- 3.58% in CRF1, 2, 3 respectively],while PHA induced T-cell proliferation was significantly higher in CRF1 [77.54 +/- 3.97 vs. 73.7 +/- 4.83 vs. 59.9 +/- 7.37% in CRF1, 2, 3, respectively]. Duration of dialysis [DX] was significantly shorter in CRF1 [15.6 +/- 5.94 vs. 33.57 +/- 11.9 vs. 79.7 +/- 30.2 months in CRF1, 2, 3, respectively]. There was no significant difference between the 3 subgroups in dose or duration of 1-alpha-calcidol treatment. CRF1 had significantly higher s-phosphorus and s-PTH, significantly lower PHA induced T-cell proliferation and insignificant difference in serum calcium and T-lymphocytes pre-activation when compared to N [5.32 +/- 0.41 vs. 3.39 +/- 0.64 mg%, 30.08 +/- 4.89 vs. 19 +/- 4.57 pg/ml, 77.54 +/- 3.97 vs. 84.8 +/- 2.8%, 9.73 +/- 1.07 vs. 9.92 +/- 0.48 mg% and 28 +/- 3.94 vs. 29.2 +/- 4.73%,respectively]. DX had a significantly +ve correlation with either PTH level or T-lymphocytes pre-activation and a significantly -ve correlation with PHA induced T-cell proliferation. PTH had a significantly +ve correlation with T-lymphocytes pre-activation and a significantly -ve correlation with PHA induced T-cell proliferation. The study concluded that increased DX duration is responsible for: Significant increase in s-PTH; increased resistance of parathyroid to suppression by 1-alpha-calcidol and progressive deterioration of T-cell function as proved by increased T-lymphocytes pre-activation and decreased PHA induced T-cell proliferation

Flowcytometric study of activated lymphocytes in chronic hepatitis C: study of the impact of treatment by interferon

The aim of this work was to study T-cell function in patients with chronic HCV infection. It included 50 subjects [38 males and 12 females] aged between 23 and 42 years old [mean age 30.97 +/- 4.48 years] divided into two main categories. The first category included 40 subjects with chronic HCV infection and further subdivided into four groups [ten patients each] according to the type of treatment received: Group 1 had a long-term remission after interferon treatment, group 2 was on a nonspecific treatment, group 3 did not receive any treatment and group 4 was resistant to interferon treatment. The second category was composed of only one group of ten normal control subjects. All studied subjects were free from all other hepatitis viruses [A, B and D viruses], were not diabetic and did not receive any immunosuppressive drugs either before, during or after the study. All subjects in the different groups were subjected to an immunological profile study which was based on the assays of peripheral blood mononuclear cell [pBMC] including total B-and T- cells, CD4, CD8, NK-cells and CD69 by flow cytometry using monoclonal antibodies. The result of this work revealed no significant statistical difference between the five studied groups. This may be attributed to different CD4 T-cell subsets, termed Th1 that may be activated in individual patient and an efficient virus control or elimination may depend upon an appropriate lymphokine profile of HCV specific CD4 T-lymphocyte