Pro-inflammatory effect of C-reactive protein and interleukin-6 in pre dialysis patients and its relation to atherothrombotic profile

The present study was undertaken to determine the level of circulating C-reactive protein and interleukin-6 in the sera of predialysis chronic renal failure patients and to correlate the levels of CRP and IL-6 with renal function. This study was carried out in Internal Medicine Departments and Tanta university hospitals during the period from September 2003 to April 2005. fifty five subjects were included in this study. They were divided into two main groups. Group I [n = 15] healthy individuals [9 males and 6 females] with mean age 51.1 +/- 9.8 years as a control group ,Group II [n - 40] predialysis chronic renal failure patients [24 males and 16females] with mean age 52.3 +/- 77.5 years. 16patients [40%] were chronic glomerulonephritis, 4 patients [10%] were chronic interstitial nephritis, 3 patients [7.5%] were poly cystic kidney disease, 1 patient [2.5%] was hydronephrosis and 16 patient] 40%] were of unknown causes. They had no other predisposing factors that may elevate the serum levels C-reactive protein or Interleukin-6 e.g infection, diabetes mellitus, other systemic inflammatory diseases or auto immune diseases. This group was subdivided into two subgroups: subgroup [a]: included patients with creatinine clearance 25 ml/min or more [n = 18], and subgroup [b]: included patients with creatinine clearance less than 25 ml/min [n = 22]. All subjects were subjected to full history taking, complete physical examination, abdominal ultrasound and the following investigations : serum creatinine, creatinine clearance, urea, albumin, total serum cholesterol, triglycerides, HDL, LDL, C-reactive protein and interleukin-6. Mean CRP in control group was 2.87 +/- 1.13 mg/L, while in patients group was 10.44 +/- 7.64 mg/L with a highly significant increase in patients group than control group [P < 0.000 1]. Mean CRP in subgroup [a] was 5.08 +/- 2.25 mg/l, while in subgroup [b] was 14.83 +/- 7. 71mg/l with a highly significant increase in subgroup [b] than subgroup [a] [P < 0.0001] Mean IL-6 in control group was 2.37 +/- 1.02 pg/ml, while in patients group was7.39 +/- 4.47 pg/ml ,with a highly significant increase in the group II than the control group [P < 0.0001] Mean IL-6 in subgroup [a] was 4.60 +/- 1.92 pg/ml, while in subgroup [b] was 9.67 +/- 4.70 pg/ml with a highly significant increase in subgroup [b] than subgroup [a] [p < 0.0001]. Significant inverse correlation between creatinine clearance and CRP was found [CRP versus Cr.clr = 0.704, P < 0.0001]. Also, a negative correlation was found between Cr.clr and IL-6 [IL-6 versus Cr.clr = -0.593, P < 0.0001]. There was mild significant correlation between creatinine clearance and HDL [P = 0.001]. A significant correlation between CRP and IL-6 [r = 0.637, P < 0.0001]. Negative significant correlation was found between CRP and albumin [CRP versus albumin r = -0.57, P < 0.0001]. There was increase in CRP and IL-6 and so inflammation and tissue damage, atherosclerosis, coronary and vascular disease with slight hyperlipidemia, which confirm that inflammation have a cardinal role in vascular disease, atherosclerosis and tissue damage in predialysis chronic renal failure patients

Assessment of left ventricular cardiac function using doppler tissue imaging and serum cardiac troponin I in Egyptian children with rheumatic carditis

With the progress of Doppler echocardiography, many new findings have been accumulated concerning changes in valvular morphology and hemodynamics of rheumatic mitral valve disease. This study aimed to evaluate the ventricular function in children with rheumatic carditis, particularly in cases of silent carditis. The present study was carried out on thirty children suffering from rheumatic fever. Their ages ranged from 5-15 years [8.96 +/- 2.49]. They were 19 males and 11 females. They were selected from children who were admitted into Pediatric department and who were attending the Pediatric Cardiology Outpatient clinic of Tanta University Hospital during the period from September 1, 2000 to March 1, 2002. These children were classified into 2 groups based on the presence or absence of clinically heard organic murmurs. Group I included 20 children with clinical signs of carditis, evidenced by presence of organic murmurs, congestive heart failure, or pericarditis with or without other manifestations of rheumatic fever. Group II included 10 children with rheumatic fever but with no clinical signs of cardiac involvement [they were proved to have valvular lesions after examination by echocardiography, i.e., silent carditis. All children included in the present study were subjected to: 1] thorough histoiy taking and complete clinical examination with emphasis on cardiovascular system evaluation, 2] chest and heart X-ray, 3] routine laboratory investigations: ESR, ASOT, CRP, complete blood count, blood urea and serum creatinine, 4] determination of serum cardiac troponin-l [cTi] by sandwich immunoassay immediately at the time of diagnosis, 5] routine echo-Doppler evaluation, 6] Doppler tissue imaging [DTI] to evaluate ventricular diastolic function and compare it with transmitral flow pattern by conventional pulsed echo-Doppler. We concluded that children with rheumatic fever may present with carditis but with no clinically heard murmurs, i,e, silent carditis, and the use of echocardiography helps in detecting such cases. The use of DTI, a noninvasive technique, is considered as a great advance in evaluation of systolic and diastolic functions of the heart in children with rheumatic carditis to help planning for a perfect management of these children. It was also concluded that serum cTi, which is considered as a marker for myocardial cell injury significantly correlates with the degree of diastolic function [i.e., e/a ratio detected by DTI] of the left ventricle