Outcomes of SGLT2 Inhibitors Use in Diabetic Renal Transplant Patients.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are newly introduced hypoglycemic drugs that work by inhibiting glucose reabsorption at proximal renal tubules. The use of SGLT2 inhibitors in nontransplant diabetic patients with or without cardiovascular disease has well-established efficacy and safety. The risks of renal graft dysfunction and urinary tract infections might be the limiting factors for their use in renal transplant patients. Data regarding the safety and long-term efficacy of SGLT2 inhibitors use in diabetic renal transplant patients is scanty. The aim of the study is to report our experience with use of SGLT2 inhibitors in 8 diabetic renal transplant patients supported by literature review. Eight diabetic renal transplant patients were recruited from Tawam hospital during the period between June 2016 and January 2019. Demographic, clinical, and laboratory data were collected and analyzed. Adding SGLT2 resulted in significant decrease in hemoglobin A1c and body mass index after 12 months of treatment. There was significant negative correlation between the duration of treatment with SGLT2 and hemoglobin A1c. Diabetic renal transplant patients with stable kidney function had better glycemic control with use of SGLT2 inhibitors. There was no deterioration of kidney function and risk of recurrent urinary tract infection was low.

Maternal and cord blood prolactin level and pregnancy complications.

OBJECTIVES: To explore the correlation between maternal and cord blood prolactin, the correlation between cord prolactin and birth weight, and to compare cord blood prolactin in new-borns of women with normal pregnancy and women with pregnancy complications namely; gestational hypertension, gestational diabetes and preterm labour. METHODS: This study was performed from September to December 2018. Thirty-two women, delivered at Baghdad teaching hospital, and their newborns (32) were included. Maternal blood (5 ml) was taken before labour and cord blood (5 ml) was collected after placenta expulsion. Maternal and cord blood prolactin were analysed using fluorescence immunoassay. RESULTS: Cord blood prolactin was higher in babies born to hypertensive women (405.28±77.52 ng/ml) than normal pregnancy women (244.80±60.80 ng/ml), P=0.000. Also, cord prolactin in gestational hypertension group was significantly higher than diabetic (P=0.006) and preterm labour (P=0.000) groups. No significant difference was noticed in cord blood prolactin in newborns of diabetic and normal pregnancy women (299.28±37.01, 244.80±60.80 ng/ml respectively, P=0.053). Preterm babies had lower cord prolactin (204.57±22.90 ng/ml) than normal pregnancy babies (244.80±60.80 ng/ml), however the difference was non-significant, P=0.118. Positive correlation was found between cord and maternal prolactin (P=0.000) and between cord prolactin and birth weight (P=0.018). CONCLUSION: Cord blood prolactin is high in newborns of hypertensive women, low in preterm neonates. Diabetes has no effect on cord prolactin level.

GFR estimation in the morbidly obese pre- and postbariatric surgery: one size does not fit all.

BACKGROUND: Glomerular hyperfiltration commonly associated with obesity is expected to improve postbariatric surgery. However, formula-based glomerular filtration rate (GFR) estimation in these patients is limited by body size confounders necessitating use of modified equations, the reliability of which remains uncertain. METHODS: In this study, various GFR-estimating formulae were compared in morbidly obese patients at baseline and postbariatric surgery. Through a retrospective chart review, we identified 220 patients who had undergone this procedure, with over 6-month follow-up, during which major weight reduction was achieved. RESULTS: A significant decrease in BP and glomerular hyperfiltration was observed, though there was large variability in GFR estimation using the different formulae. Gross over and underestimation was observed which improved with correction for body size confounders especially lean body weight (LBW). Postoperatively, significant attenuation in estimated GFR was demonstrated when LBW or body surface area-adjusted versions were used. In a subgroup of patients with chronic kidney disease, a significant improvement in GFR was seen postoperatively with the LBW-modified formula but there were again inconsistencies when using other equations. CONCLUSION: Though clinicians must be critical in the application of GFR estimates to patient care, LBW adjustment appears to be the most practical solution to its estimation in the obese patients. This is particularly true for patients with normal renal function but appears to be also applicable to those with compromised kidney function. Future studies are needed to compare these equations with a gold standard GFR measure as well as to explore whether the renal benefits from bariatric surgery are sustained or seen in more advanced CKD stages.