Hepatitis C virus [HCV] antibodies in patients with chronic renal failure and treated with regular hemodialysis and those treated with renal transplantation

This work was carried out to study the prevalence of hepatitis C Virus [HCV] infection, its associated risk factors and possible routes of transmission in chronic renal failure patients treated with either regular hemodialysis or renal transplantation. Seventy patients and 20 normal controls were included in this study. Patients were classified into 2 groups: Group I: 50 hemodialysis patients [HD group] and Group II: 20 renal transplant recipients [RTR group]. Each individual was subjected to full clinical examination, estimation of serum alanine aminotransferase [ALT], testing for antibodies to hepatitis C virus [anti-HCV] by ELISA 2nd generation, screening for hepatitis B surface antigen [HBsAg], antibodies to hepatitis B surface antigen [anti-HBs] and core antigen [anti HBc] by modified ELISA technique. Anti-HCV was found in 72% of hemodialysis patients and 65% of renal transplant patients and in 15% of the control group. There was a significant correlation between the presence of anti-HCV and the duration on dialysis in HD and RTR groups [P < 0.05 in both], while no significant correlation was detected between HCV positive cases and the number of units of transfused blood in HD and RTR groups [P > 0.05 in both]. Serum ALT was elevated in patients with HCV infection, but there was no significant correlation between the presence of anti-HCV and elevated ALT level among the examined groups of patients [P > O.OS in both]. The prevalence of HCV infection was not correlated with the duration of renal transplantation [P>0.05] and the type of immunosuppressive therapy [P > 0.05]. Coinfection with HBV and HCV could occur, as previous infection with HBV was demonstrated. Anti-HBc was found in 33.3% and 30.8% of anti-HCV positive patients in both HD and RTR groups respectively. Anti-HBs was detected in 25% and 15.4% of anti HCV positive in HD and RTR groups. HBsAg was found in 5.6% of anti-HCV positive hemodialysis patients. From this study we concluded that there are high prevalence of antibodies to HCV in serum of these patients with CRF whether treated with regular hemodialysis or with renal transplantation. This may mean high prevalence of HCV infection in these patients. Also it is found that the duration of hemodialysis rather than the number of units of blood transfusion is the main risk factor and that the transmission in hemodialysis units is the most important rather than by blood transfusion although its importance. Also we may recommend [1] All the hygienic measures to prevent spread of hepatitis C virus infection in these patients and treatment of cases. [2] Separate dialysis machines should be used for anti-HCV positive patients as we do for HBsAg positive patients. [3] Routine application of PCR technique in these patients may be useful for accurate diagnosis of the HCV infection. [4] Retrospective study on large number of transplanted patients for all risk factors of HCV infection, in addition to study the causes of this relatively high prevalence of infection inbetween them

Study of blood coagulation and fibrinolysis in obese non-insulin dependent diabetes mellitus [NIDDM] patients

Four groups of age and sex matched patients were studied: group 1:20 nondiabetic subjects with a body mass index [BMI] <25 kg/m[2] [lean control subjects]; group 11:20 obese non diabetic subjects with a BMI>30 kg/m[2] group; 111:20 lean NIDDM subjects; and group IV.-20 obese NIDDM subjects. We determined: blood glucose, total cholesterol, triglycerides, HDL-Cholesterol, Apolipoprotein Al and B, insulin, Lipoprotein [a] [Lp[a]], fibrinogen, Factor VII, plasminogen, tissue plasminogen activator antigen[t-PA] [Ag] pre and post venous occlusion [VO] and plasminogen activator inhibitor [PAI] activity pre and post VO [VO test is a physiological stress test used to study the fibrinolytic activity]. In addition to metabolic abnormalities obese non diabetic subjects and lean and obese NIDDM patients displayed significantly higher levels of fibrinogen, Factor VII, plasminogen, PAI pre and post VO and t-PA [Ag] pre VO and significantly lower levels of t-PA [Ag] post VO. Our findings demonstrate an impairment of the haemostatic and fibrinolytic mechanisms which may be a key role in the pathogenesis of atherosclerotic vascular complications in obesity and in NIDDM. From this study we can recommend the following 1] Prophylaxis and early tretment of obesity 2] Early and proper treatment of NIDDM. 3] Early and proper treatment of any metabolic abnormalities as regards lipids or carbohydrate metabolism, and proper treatment of atherosclerosis

Silent myocardial ischaemia [SMI] in non-insulin dependent diabetic men and its relation to diabetic autonomic neuropathy

Treadmill exercise test was performed in 100 non-insulin dependent diabetic men not suffering from symptoms of coronary artery disease [asymptomatic Diabetic Group] and 40 none diabetic control subjects [Control Group], to detect the prevalence of SMI in the asymptomatic diabetic group, and to be compared with the control group. Thirty sex% of diabetic patients were found positive for SMI in treadmill test, this is to be compared with only 5% of subjects in the control group, the difference in between was statistically significant [P < 0.05]. When we evaluated autonomic neuropathy in the diabetic group we found that 44% of these patients had diabetic autonomic neuropathy. Also diabetic autonomic neuropathy was found in 69.4% in treadmill positive patients, this is to be compared with 29.7% in treadmill negative patients, the difference in between was statistically significant [P < 0.05]. From this study we concluded that silent myocardial ischaemia in asymptomatic diabetic men occurrs frequently and in association with autonomic neuropathy, suggesting that diabetic autonomic neuropathy may be implicated in the mechanism of silent myocardial ischaemia. We recommend careful screening of diabetic patients with treadmill test to detect SMI for proper management of this risky diabetic complication

Study of urinary transferrin and iron excretion in insulin dependent diabetes mellitus [IDDM] with variable degrees of albuminuria

This study included 60 insulin dependent diabetic male patients in 3 groups according to urinary albumin excretion. Group I with normal albuminuria [urine albumin < 30 mg/day], group II with microalbuminuria [urine albumin 30-300 mg/day] and group III with macroalbuminuria [urine albumin > 300 mg/day]. Each diabetic group included 20 cases and these groups were compared with control group comprised of 20 healthy subjects. The present work was undertaken to study urinary transferrin and iron in diabetic patients with varying amounts of albuminuria. The following were the results of this work: -There was significant increase [P < 0.05] in urinary transferrin and iron in all the studied diabetic groups compared to the normal controls, and this increase occurrs early in the course of the diabetic renal disease. -The iron/transferrin ratio in urine was much higher than that in serum in all the diabetic groups. This means that iron is present in the urine in marked excess than its carrier transferrin. -There was significant positive correlation [P < 0.05] between urinary albumin and urinary transferrin in both the micro and macro albuminuric diabetic groups. -There was significant positive correlation [P < 0.05] between urinary albumin and urinary iron in all the diabetic groups. -There was significant positive correlation [P< 0.05] between urinary iron and urinary transferrin in the macroalbuminuric diabetic group. From this work we can conclude the following: -Transferrin which has the similar molecular size as albumin, its urinary excretion in excess as well as the excess excretion of urinary iron in diabetics may suggest the possibility of development of glomerular disease and nephropathy. -Urinary iron excretion is increased early in the course of diabetic renal disease. The fact that iron is present in the urine in marked excess of transferrin further suggests that either iron is dissociated from transferrin in the tubule fluid with transferrin being reabsorped, or that iron is added to the tubule fluid by means other than filtration without transferrin. This finding suggests that iron could be present in tubule fluid in a form which would catalyze the Haber- Weiss reaction with the formation of free radicals resulting in tubulointerstial injury. -The increase of urinary iron excretion in diabetics may reduce iron stores making the individuals more at risk of developing iron deficiency if there are other causes of iron or blood loss. We recommended detection of urinary transferrin and iron in IDDM patients as their excretion in excess may suggest the possibility of development of glomerular disease and nephropathy which may need further investigations and follow up for proper management of this risky diabetic complication

Serum lipid profile and lipoprotein [a] in patients with chronic renal failure [CRF] under different methods of therapy

Eighty subjects [60 patients with chronic renal failure [CRF] under different method of therapy, in addition to 20 healthy normal control subjects] were included in this study. They were subdivided into the following groups. Group I: included 20 normal health subjects as controls. Group II: included 20 patients of CRF under conservative treatment. Group III: included 20 patients of CRF under haemodialysis [HD]. Group IV: included 20 patients of CRF under chronic peritoneal dialysis [CPD]. For all groups serum lipid profile was done including serum triglycerides total cholesterol, HDL-C, LDL-C, HDL-C/ LDL-C ratio, ApoA, ApoB, ApoA/ApoB ratio and Lipoprotein [a] [Lp[a]], And we get the following results: There was a significant increase in serum triglycerides in different groups of CRF under different methods of therapy [conservative treatment, haemodialysis and chronic peritoneal dialysis] [P < 0.001 for all]. There was a significant increase in total serum cholesterol in patients with CRF under chronic peritoneal dialysis [P < 0.001], but non significant changes in the conservative treatment [P > 0.05] and haemodialysis [P > 0.05] groups. There was a significant decrease in HDL-C in all the studied groups of CRF under different methods of therapy [P< 0.001 for all]. There was a significant increase in LDL-C in CRF patients under CPD [P < 0.001, and non significant chnages in its level in the conservative treatment and HD groups [P > 0.05 for both]. There was a significant decrease in HDL - C/LDL-C ratio in all groups of CRF under different methods of therapy [conservative treatment [P < 0.001], HD [P < 0.01] and CPD [P<0.001]]. There was a significant decrease in ApoA in all groups of CRF under different methods of therapy [P < 0.001 for all]. There was a significant increase in ApoB in CPD group [P < 0.001] and non significant changes in both the conservative treatment and haemodialysis groups [P > 0.05 for both]. There was a significant decrease in ApoA /ApoB ratio in all groups of CRF under different methods of therapy [P < 0.001 for all]. There was a significant increase in serum LP [a] in all groups of CRF under different methods of therapy [P < 0.001 for all]. The level of LP [a] in both the HD and the CPD groups both before and after dialysis was non significantly changed. There was significant negative correlation between Lp [a] and both of HDL - C / LDL -C ratio [P < 0.05 for all groups] and Apo A /Apo B ratio [P < 0.05 for all groups]. There was a significant Positive correlation between serum level of Lp [a] and the duration of treatment for conservative treatment group [P < 0.05], and non significant changes in both HD and CPD groups [P > 0.05 for both]. There are changes in serum lipid profile and Lp [a] in CRF patients under different methods of therapy which share with other factors for increasing succeptibility to atherogenecity in these patients

Pituitary-testicular axis in men with chronic renal failure [CRF] undergoing regular hemodialysis and after renal transplantation

Pituitary testicular hormonal axis was studied in fifteen [15] male patients with chronic renal failure treated with regular hemodialysis, their ages ranged from 27 - 55 years, and in other ten [10] male renal transplant recipients [CRF patients whose treated by successful renal transplantation], they were studied 9- 18 months after renal transplantation, their ages ranged from 27 - 37 years. Ten [10] healthy adult males were chosen as control group, their ages ranged from 27 - 48 years. Assessment of follicle stimulating hormone [FSH], luteinzing hormone [LH], prolactin, testosterone and dehydroepinandrosterone sulfate in serum was done, also testosterone suppression test to luteinizing hormone was also done in a random group of dialyzed patients [7 patients] and we found serum FSH. LH and prolactin were significantly increased [P < 0.001] in dialyzed group as compared to control group; while testosterone and dehydroepiandrosterone sulfate were significantly decreased [P < 0.001], the testosterone suppression test in dialyzed group showed integrity of this axis. In renal transplant group serum FSH, prolactin, testosterone and dehydroepiandrosterone sulfate were non significantly changed when compared to control group but LH was significantly decreased [P < 0.001] when compared to both control and dialyzed groups. From this study, we conclude that pituitary testicular hormonal axis still intact in those paients with CRF undergoing regular hemodialysis and that renal transplantation can correct the pituitary testicular hormonal pattern more or less near to normal