Pub Date : 2023-07-01DOI: 10.4103/jesnt.jesnt_24_22
S. Kamel, N. Ahmed, Muhammed El Moety, Nayel El Hameed
Background Diabetes mellitus (DM) is a group of metabolic disorders that are defined by the presence of levels over a prolonged period. Many complications arise from the long-term standing of hyperglycemia, among which is diabetic nephropathy. Irisin is a newly described exercise-mediated myokine that regulates energy metabolism by converting white into brown fat. Irisin is produced upon cleavage of the precursor plasma membrane protein fibronectin type-III domain-containing protein 5 (FNDC5) and enters the circulation. Irisin was found to be associated with renal functions in chronic kidney disease patients and diabetic nephropathy patients. Patients and methods This study was conducted on 69 Egyptian adult patients (50 females and 19 males), including 53 patients of type-2 diabetics (38 diabetics only and 15 diabetic nephropathy) and 16 healthy controls matched with the patients for the ethnic and demographic characteristics. Serum irisin and insulin were evaluated by enzyme-linked immunosorbent assay. Genomic DNA was genotyped for FNDC5 rs3480 polymorphism using TaqMan genotyping assay. Results We found that irisin level was lower in T2DM (mean±SD=13.11 + 38.14) and diabetic nephropathy (mean±SD=24.99 ± 48.8) patients than controls (mean±SD=13.39 + 26.2) with no significance. The results of our study showed no association between the FNDC5 rs3480 genotype AG [in comparison between control and diabetic nephropathy odds ratio=0.5 (0.1–2.2) with P=0.5]. Also, the AA genotype [odds ratio=2.6 (0.59–11.06), P=0.2] did not show a significant effect on nephropathy in T2DM. Conclusion This study demonstrated that FNDC5 gene rs3480 A>G polymorphism provides a weak risk with no apparent significance of nephropathy on T2DM without effect on serum irisin level. T2DM is associated with decreased levels of circulating irisin, but it was increased in diabetic patients with nephropathy.
{"title":"Fibronectin type-III domain-containing protein 5 genetic polymorphism and serum irisin-level change in relation to type-2 diabetes mellitus with diabetic nephropathy","authors":"S. Kamel, N. Ahmed, Muhammed El Moety, Nayel El Hameed","doi":"10.4103/jesnt.jesnt_24_22","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_24_22","url":null,"abstract":"Background Diabetes mellitus (DM) is a group of metabolic disorders that are defined by the presence of levels over a prolonged period. Many complications arise from the long-term standing of hyperglycemia, among which is diabetic nephropathy. Irisin is a newly described exercise-mediated myokine that regulates energy metabolism by converting white into brown fat. Irisin is produced upon cleavage of the precursor plasma membrane protein fibronectin type-III domain-containing protein 5 (FNDC5) and enters the circulation. Irisin was found to be associated with renal functions in chronic kidney disease patients and diabetic nephropathy patients. Patients and methods This study was conducted on 69 Egyptian adult patients (50 females and 19 males), including 53 patients of type-2 diabetics (38 diabetics only and 15 diabetic nephropathy) and 16 healthy controls matched with the patients for the ethnic and demographic characteristics. Serum irisin and insulin were evaluated by enzyme-linked immunosorbent assay. Genomic DNA was genotyped for FNDC5 rs3480 polymorphism using TaqMan genotyping assay. Results We found that irisin level was lower in T2DM (mean±SD=13.11 + 38.14) and diabetic nephropathy (mean±SD=24.99 ± 48.8) patients than controls (mean±SD=13.39 + 26.2) with no significance. The results of our study showed no association between the FNDC5 rs3480 genotype AG [in comparison between control and diabetic nephropathy odds ratio=0.5 (0.1–2.2) with P=0.5]. Also, the AA genotype [odds ratio=2.6 (0.59–11.06), P=0.2] did not show a significant effect on nephropathy in T2DM. Conclusion This study demonstrated that FNDC5 gene rs3480 A>G polymorphism provides a weak risk with no apparent significance of nephropathy on T2DM without effect on serum irisin level. T2DM is associated with decreased levels of circulating irisin, but it was increased in diabetic patients with nephropathy.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125055925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/jesnt.jesnt_29_22
Hesham Aboeleil, H. Hebah, Aya Magdi, F. Ahmed
Background Early detection of DN helps in primary prevention of this complication. Microalbuminuria has been proven as a useful biomarker for diagnosis of DN. Heme oxygenase-1 is an essential enzyme in heme catabolism induced by oxidative stress. It plays a pivotal role in maintaining renal function and protecting renal structure under conditions of oxidative stress such as proteinuria. Urinary heme oxygenase-1 may appear early before the development of microalbuminuria, so it can be used as a marker for early detection of DN. Patients and methods A total of 80 type 2 diabetic patients with and without DN were compared with 20 healthy control subjects matched in age and sex. They were divided into two groups: group I included 40 normoalbuminuric patients with albumin-to-creatinine ratio (ACR) less than 30 mg/g, and group II included 40 microalbuminuric patients with ACR 30–300 mg/g. For all studied groups, full history and clinical examination were done. Glycosylated hemoglobin, urinary ACR (mg/g), estimated glomerular filtration rate, urinary creatinine, and urine hemoxygnase-1 (UHO-1) and UHO-1/creat ratio by enzyme-linked immunosorbent assay were performed. Results Microalbuminuric patients had significantly higher levels of UHO-1 (5.02) compared with normoalbuminuric patients (3.01) and controls (0.3), with P less than 0.001, and normoalbuminuric patients had significantly higher levels of UHO-1 compared with control subjects, with P less than 0.001. UHO-1/Cr levels were significantly positively correlated with urinary ACR but significantly negatively correlated with glomerular filtration rate and systolic and diastolic blood pressures (P<0.001). By linear regression, there was a highly significant correlation between HO1and estimated glomerular filtration rate. Conclusion HO-1 was increased in patients with proteinuria and increased before the onset of microalbuminuria, indicating UHO-1 is more sensitive than albumin for the detection of early DN with no relation to diabetic retinopathy.
{"title":"Urinary heme oxygenase-1 as a possible marker for early diagnosis of diabetic nephropathy and retinopathy","authors":"Hesham Aboeleil, H. Hebah, Aya Magdi, F. Ahmed","doi":"10.4103/jesnt.jesnt_29_22","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_29_22","url":null,"abstract":"Background Early detection of DN helps in primary prevention of this complication. Microalbuminuria has been proven as a useful biomarker for diagnosis of DN. Heme oxygenase-1 is an essential enzyme in heme catabolism induced by oxidative stress. It plays a pivotal role in maintaining renal function and protecting renal structure under conditions of oxidative stress such as proteinuria. Urinary heme oxygenase-1 may appear early before the development of microalbuminuria, so it can be used as a marker for early detection of DN. Patients and methods A total of 80 type 2 diabetic patients with and without DN were compared with 20 healthy control subjects matched in age and sex. They were divided into two groups: group I included 40 normoalbuminuric patients with albumin-to-creatinine ratio (ACR) less than 30 mg/g, and group II included 40 microalbuminuric patients with ACR 30–300 mg/g. For all studied groups, full history and clinical examination were done. Glycosylated hemoglobin, urinary ACR (mg/g), estimated glomerular filtration rate, urinary creatinine, and urine hemoxygnase-1 (UHO-1) and UHO-1/creat ratio by enzyme-linked immunosorbent assay were performed. Results Microalbuminuric patients had significantly higher levels of UHO-1 (5.02) compared with normoalbuminuric patients (3.01) and controls (0.3), with P less than 0.001, and normoalbuminuric patients had significantly higher levels of UHO-1 compared with control subjects, with P less than 0.001. UHO-1/Cr levels were significantly positively correlated with urinary ACR but significantly negatively correlated with glomerular filtration rate and systolic and diastolic blood pressures (P<0.001). By linear regression, there was a highly significant correlation between HO1and estimated glomerular filtration rate. Conclusion HO-1 was increased in patients with proteinuria and increased before the onset of microalbuminuria, indicating UHO-1 is more sensitive than albumin for the detection of early DN with no relation to diabetic retinopathy.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115032436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/jesnt.jesnt_30_22
M. Elsayed, I. Elgohary, S. Abouelnaga, Fathyia Elian, M. Zeid
Background Hypomagnesemia is a common electrolyte abnormality following kidney transplantation. Increased renal magnesium (Mg) waste has been linked to calcineurin inhibitors. We aimed to assess the prevalence and risk factors of hypomagnesemia and its association with calcineurin inhibitor use in renal transplant recipients. Patients and methods This is a cross-sectional study carried out on renal transplant recipients, who underwent living-related donor kidney transplantation. All participants underwent detailed history taking and complete physical examination. Serum Mg, trough level of cyclosporine or tacrolimus, fractional excretion of Mg (FEMg), and 24 h urinary Mg, Ca, Ph, Cl, and protein were measured. Results One hundred patients were screened and 80 patients, with a mean age of 39.65 ± 12.14 years, completed the study. Fifty (62.5%) patients were on tacrolimus, and 26 (32.5%) patients were on cyclosporine. Patients had a median serum Mg of 1.80 mg/dl. Hypomagnesemia (Mg<1.7) was present in 17 (21.3%) patients with a median FEMg of 3.08%. There was significant negative correlation between serum Mg level and trough level of tacrolimus and FEMg with a P value of 0.038 and 0.001, respectively. The results of multivariate analyses showed that tacrolimus trough level (P=0.010) and FEMg (P=0.025) were independently correlated with serum Mg. Hypomagnesemia was significantly higher in tacrolimus-treated patients (30%) compared with only 7.7% in cyclosporine-treated patients (P=0.027). Conclusions Hypomagnesemia is common in renal transplant recipients, especially with tacrolimus use mostly due to increased renal Mg wasting. Increased tacrolimus trough level and increased FEMg were predictors of hypomagnesemia.
{"title":"Hypomagnesemia and its association with calcineurin inhibitor use in renal transplant recipients","authors":"M. Elsayed, I. Elgohary, S. Abouelnaga, Fathyia Elian, M. Zeid","doi":"10.4103/jesnt.jesnt_30_22","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_30_22","url":null,"abstract":"Background Hypomagnesemia is a common electrolyte abnormality following kidney transplantation. Increased renal magnesium (Mg) waste has been linked to calcineurin inhibitors. We aimed to assess the prevalence and risk factors of hypomagnesemia and its association with calcineurin inhibitor use in renal transplant recipients. Patients and methods This is a cross-sectional study carried out on renal transplant recipients, who underwent living-related donor kidney transplantation. All participants underwent detailed history taking and complete physical examination. Serum Mg, trough level of cyclosporine or tacrolimus, fractional excretion of Mg (FEMg), and 24 h urinary Mg, Ca, Ph, Cl, and protein were measured. Results One hundred patients were screened and 80 patients, with a mean age of 39.65 ± 12.14 years, completed the study. Fifty (62.5%) patients were on tacrolimus, and 26 (32.5%) patients were on cyclosporine. Patients had a median serum Mg of 1.80 mg/dl. Hypomagnesemia (Mg<1.7) was present in 17 (21.3%) patients with a median FEMg of 3.08%. There was significant negative correlation between serum Mg level and trough level of tacrolimus and FEMg with a P value of 0.038 and 0.001, respectively. The results of multivariate analyses showed that tacrolimus trough level (P=0.010) and FEMg (P=0.025) were independently correlated with serum Mg. Hypomagnesemia was significantly higher in tacrolimus-treated patients (30%) compared with only 7.7% in cyclosporine-treated patients (P=0.027). Conclusions Hypomagnesemia is common in renal transplant recipients, especially with tacrolimus use mostly due to increased renal Mg wasting. Increased tacrolimus trough level and increased FEMg were predictors of hypomagnesemia.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132299038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/jesnt.jesnt_23_22
H. Abdulaziz, N. Sayed-ahmed, Dina Atwa, M. Nassar
Background Glomerular diseases (GDs) place a significant burden on patients and health care systems, and they are a leading cause of end-stage renal disease (ESRD) globally. There is no national register for GDs in Egypt, and the outcomes of GDs are not extensively examined. As a result, studying GD patterns and outcomes, as well as the association between chronic renal injury at presentation and GD outcomes, was of great interest. Patients and methods Patients with biopsy-proven GDs presenting to an Egyptian tertiary care center were enrolled and prospectively followed up for 6 months, until death or reaching ESRD. Chronic renal damage was assessed at diagnosis by calculating the total renal chronicity. Results A total of 66 individuals with biopsy-confirmed GDs were enrolled in the study. Unexplained decrease in kidney function (62%), subnephrotic (23%), and nephrotic presentation (15%) were the most common reasons for a renal biopsy. The most common histological patterns were diffuse proliferative glomerulonephritis (GN), membranoproliferative GN, and sclerosing GN. Primary and secondary GDs made up 30.3 and 69.7% of the cases, respectively. At the end of the 6-month follow-up, 28 patients had recovered their renal function, 19 had advanced to ESRD, and seven had died. Hemoglobin level and the total renal chronicity score were the best ways to predict how well the kidneys would get better. Conclusion In this tertiary care center Egyptian cohort, secondary GDs appeared to be more frequent than primary GDs, diffuse proliferative GN was the most common histopathological pattern, and rapid renal recovery was not the rule in this short period. The renal chronicity score could accurately predict the renal outcome.
{"title":"Clinicopathologic features, chronic renal damage, and short-term outcomes of glomerular diseases in a middle east tertiary care center","authors":"H. Abdulaziz, N. Sayed-ahmed, Dina Atwa, M. Nassar","doi":"10.4103/jesnt.jesnt_23_22","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_23_22","url":null,"abstract":"Background Glomerular diseases (GDs) place a significant burden on patients and health care systems, and they are a leading cause of end-stage renal disease (ESRD) globally. There is no national register for GDs in Egypt, and the outcomes of GDs are not extensively examined. As a result, studying GD patterns and outcomes, as well as the association between chronic renal injury at presentation and GD outcomes, was of great interest. Patients and methods Patients with biopsy-proven GDs presenting to an Egyptian tertiary care center were enrolled and prospectively followed up for 6 months, until death or reaching ESRD. Chronic renal damage was assessed at diagnosis by calculating the total renal chronicity. Results A total of 66 individuals with biopsy-confirmed GDs were enrolled in the study. Unexplained decrease in kidney function (62%), subnephrotic (23%), and nephrotic presentation (15%) were the most common reasons for a renal biopsy. The most common histological patterns were diffuse proliferative glomerulonephritis (GN), membranoproliferative GN, and sclerosing GN. Primary and secondary GDs made up 30.3 and 69.7% of the cases, respectively. At the end of the 6-month follow-up, 28 patients had recovered their renal function, 19 had advanced to ESRD, and seven had died. Hemoglobin level and the total renal chronicity score were the best ways to predict how well the kidneys would get better. Conclusion In this tertiary care center Egyptian cohort, secondary GDs appeared to be more frequent than primary GDs, diffuse proliferative GN was the most common histopathological pattern, and rapid renal recovery was not the rule in this short period. The renal chronicity score could accurately predict the renal outcome.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114639862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/jesnt.jesnt_32_22
Vandit Sevak, Rathika Chinniah, Sasiharan Pandi, R. Venkatesan, S. Krishnaswamy, Dhinakaran Thadakanathan, Balakrishnan Karuppiah
Background The present study elucidated HLA-DRB1 allele frequency, the gene expression profile of HLA-DRB1, CIITA promoters PI, PIV, and RFX5 and their association in chronic kidney disease (CKD). Patients and methods In all, 133 CKD patients and 144 healthy controls were enrolled, and qRT-PCR based expression analysis of HLA-DRB1, CIITA-PI, PIV, and RFX5 promoters was carried out. The typing of HLA-DRB1FNx01 alleles was performed by the PCR-SSP method. The immune cell profiling was performed by flow cytometry. Results Out of the 13 HLA-DRB1 alleles genotyped, increased frequencies for DRB1FNx0107 [odds ratio (OR)=2.103] and DRB1FNx0112 (OR=2.50) and decreased frequency for DRB1FNx0110 (OR=0.455) in CKD patients were observed. HLA-DRB1 expression was significantly upregulated in pooled-CKD (Fc: 1.49 ± 0.21; P<0.0001), DRB1FNx0107 (Fc: 3.10 ± 0.70; P<0.057), and DRB1FNx0112 (Fc: 3.62 ± 0.74; P<0.0001) positive CKD patients. Significantly higher levels of expressions were observed for CIITA-PI (Fc: 2.35 ± 0.23; P<0.0005) and PIV (Fc: 1.76 ± 0.23; P<0.0009) in pooled-CKD patients. With HLA-DRB1 alleles, a higher level of expressions of CIITA-PIV was observed in patients with DRB1FNx0112 (Fc: 1.45 ± 0.38; P<0.007). Interestingly, a significantly downregulated expression was observed for CIITA-PIV in patients heterozygous for DRB1FNx0112 (2.15 ± 0.24 vs. 0.16 ± 0.82; P<0.017). An upregulated RFX5 expression was observed for pooled-CKD (Fc: 1.37 ± 0.17; P<0.0001) and DRB1FNx0112 (1.40 ± 0.34; P<0.045) positive patients. Immunophenotyping analysis showed an increased CD3+ and decreased CD19+, CD4+,and CD8+ cell populations in CKD patients compared with controls. Conclusion The study confirmed the increased expression of CIITA-PI, PIV promoters, and RFX5 that in turn led to the upregulation of the DRB1 gene resulting in CKD. Thus, the study concluded the positive association of HLA-DRB1FNx0107 and DRB1FNx0112 alleles, with a differential expression of DRB1 genes as a consequence of upregulation of respective promoters in CKD pathogenesis in South India.
{"title":"Expression profile of HLA-DRB1, RFX5, and CIITA promoters in chronic kidney disease patients from South India","authors":"Vandit Sevak, Rathika Chinniah, Sasiharan Pandi, R. Venkatesan, S. Krishnaswamy, Dhinakaran Thadakanathan, Balakrishnan Karuppiah","doi":"10.4103/jesnt.jesnt_32_22","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_32_22","url":null,"abstract":"Background The present study elucidated HLA-DRB1 allele frequency, the gene expression profile of HLA-DRB1, CIITA promoters PI, PIV, and RFX5 and their association in chronic kidney disease (CKD). Patients and methods In all, 133 CKD patients and 144 healthy controls were enrolled, and qRT-PCR based expression analysis of HLA-DRB1, CIITA-PI, PIV, and RFX5 promoters was carried out. The typing of HLA-DRB1FNx01 alleles was performed by the PCR-SSP method. The immune cell profiling was performed by flow cytometry. Results Out of the 13 HLA-DRB1 alleles genotyped, increased frequencies for DRB1FNx0107 [odds ratio (OR)=2.103] and DRB1FNx0112 (OR=2.50) and decreased frequency for DRB1FNx0110 (OR=0.455) in CKD patients were observed. HLA-DRB1 expression was significantly upregulated in pooled-CKD (Fc: 1.49 ± 0.21; P<0.0001), DRB1FNx0107 (Fc: 3.10 ± 0.70; P<0.057), and DRB1FNx0112 (Fc: 3.62 ± 0.74; P<0.0001) positive CKD patients. Significantly higher levels of expressions were observed for CIITA-PI (Fc: 2.35 ± 0.23; P<0.0005) and PIV (Fc: 1.76 ± 0.23; P<0.0009) in pooled-CKD patients. With HLA-DRB1 alleles, a higher level of expressions of CIITA-PIV was observed in patients with DRB1FNx0112 (Fc: 1.45 ± 0.38; P<0.007). Interestingly, a significantly downregulated expression was observed for CIITA-PIV in patients heterozygous for DRB1FNx0112 (2.15 ± 0.24 vs. 0.16 ± 0.82; P<0.017). An upregulated RFX5 expression was observed for pooled-CKD (Fc: 1.37 ± 0.17; P<0.0001) and DRB1FNx0112 (1.40 ± 0.34; P<0.045) positive patients. Immunophenotyping analysis showed an increased CD3+ and decreased CD19+, CD4+,and CD8+ cell populations in CKD patients compared with controls. Conclusion The study confirmed the increased expression of CIITA-PI, PIV promoters, and RFX5 that in turn led to the upregulation of the DRB1 gene resulting in CKD. Thus, the study concluded the positive association of HLA-DRB1FNx0107 and DRB1FNx0112 alleles, with a differential expression of DRB1 genes as a consequence of upregulation of respective promoters in CKD pathogenesis in South India.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123612232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/jesnt.jesnt_25_22
F. Alalawi, Dawlat Belal, Ajay K. Sharma, A. Halawa
End-stage renal disease impacts fertility, causing functional menopause in female patients. Within 3 months of successful renal transplant, menstrual function normalizes, ovulation recommences due to improved hypothalamic–pituitary–ovarian axis function, and, thereby, fertility is restored in 80–90% of women in the childbearing age group. In such circumstances, any unplanned pregnancy poses a significant risk to the mother and the child, and the allograft. Pregnancy, in general, does not negatively impact long-term allograft function or survival if the baseline function of the allograft is excellent. Risk predictors of clinical adverse outcomes and graft loss during pregnancy include short transplant–pregnancy interval, preconception graft function, hypertension, preconception proteinuria, and preeclampsia. The recommended and safer maintenance immunosuppressive regimen during pregnancy is calcineurin inhibitors (CNI) (tacrolimus/cyclosporine), azathioprine, and steroids. Sirolimus/everolimus and mycophenolate mofetil should be withdrawn 6 weeks before planned conception. To avoid acute rejections, drug levels should be monitored closely, and the dosage should be modified to reach the recommended target level. Addressing contraception must be a crucial component of the pretransplant counseling process to prevent premature unplanned pregnancies. Mechanical contraceptives are safe for transplant recipients, convenient, and easy to use, with no concerns regarding interaction with immune suppressants; nevertheless, their efficacy depends on user compliance which is difficult to achieve in most cases. However, combined oral contraceptives and progestin-only contraceptives have an inhibitory effect on P 450 3A4, thus increasing the concentration of CNIs particularly cyclosporine. Furthermore, CNIs, in particular, tacrolimus, have an inductive effect on P 450 3A4, potentially reducing the contraceptive efficacy. Therefore, successful pregnancy depends on thorough prepregnancy counseling, careful family planning, and multidisciplinary teamwork. Breastfeeding is not contraindicated and should not be discouraged.
{"title":"Current approaches in managing pregnancy in kidney transplant recipients","authors":"F. Alalawi, Dawlat Belal, Ajay K. Sharma, A. Halawa","doi":"10.4103/jesnt.jesnt_25_22","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_25_22","url":null,"abstract":"End-stage renal disease impacts fertility, causing functional menopause in female patients. Within 3 months of successful renal transplant, menstrual function normalizes, ovulation recommences due to improved hypothalamic–pituitary–ovarian axis function, and, thereby, fertility is restored in 80–90% of women in the childbearing age group. In such circumstances, any unplanned pregnancy poses a significant risk to the mother and the child, and the allograft. Pregnancy, in general, does not negatively impact long-term allograft function or survival if the baseline function of the allograft is excellent. Risk predictors of clinical adverse outcomes and graft loss during pregnancy include short transplant–pregnancy interval, preconception graft function, hypertension, preconception proteinuria, and preeclampsia. The recommended and safer maintenance immunosuppressive regimen during pregnancy is calcineurin inhibitors (CNI) (tacrolimus/cyclosporine), azathioprine, and steroids. Sirolimus/everolimus and mycophenolate mofetil should be withdrawn 6 weeks before planned conception. To avoid acute rejections, drug levels should be monitored closely, and the dosage should be modified to reach the recommended target level. Addressing contraception must be a crucial component of the pretransplant counseling process to prevent premature unplanned pregnancies. Mechanical contraceptives are safe for transplant recipients, convenient, and easy to use, with no concerns regarding interaction with immune suppressants; nevertheless, their efficacy depends on user compliance which is difficult to achieve in most cases. However, combined oral contraceptives and progestin-only contraceptives have an inhibitory effect on P 450 3A4, thus increasing the concentration of CNIs particularly cyclosporine. Furthermore, CNIs, in particular, tacrolimus, have an inductive effect on P 450 3A4, potentially reducing the contraceptive efficacy. Therefore, successful pregnancy depends on thorough prepregnancy counseling, careful family planning, and multidisciplinary teamwork. Breastfeeding is not contraindicated and should not be discouraged.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"81 24","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113933322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/jesnt.jesnt_36_22
E. Khaled, Elena Ahmed, Kora Mahmoud, Tawfeek Ahmed, Dewidar Noha
Background Glomerulonephritis (GN) is still the main cause of renal morbidity and mortality in the developing world. Knowledge about the characteristics of GN and its regional trends is mandatory for proper management of chronic kidney disease to decrease the incidence of progression to end-stage kidney disease. The aim of this study is to identify the patterns and frequency of glomerular lesions (biopsy-proven). Patients and methods This is a retrospective study that included 140 adult patients who underwent renal biopsies at Menoufia University Hospitals between August 2017 and December 2019. Patient demographics, clinical, laboratory, and histopathological data were recorded. The obtained data were analyzed using descriptive and inferential statistics. Results The studied patients were 72 (51.4%) males and 68 (48.6%) females, and their mean age was 36.11 ± 14.57 years. Focal segmental glomerulosclerosis (FSGS) was the most frequent cause of primary GN (21.4%) followed by membranous GN (13.6%), minimal change disease (5.7%), and membranoproliferative GN (3.6%). Lupus nephritis (LN) was reported as the most common in secondary GN (18.6%), followed by vasculitis (12.1%), amyloidosis (5.7%), thrombotic microangiopathy (4.3%), and infection-related GN (3.6%). The most common presentation was peripheral edema (80.7%), followed by acute kidney injury (14.3%). FSGS (12.1%) was the most common subtype of primary GN associated with renal insufficiency followed by membranous GN (10%). Vasculitis was the most common subtype of secondary GN associated with renal insufficiency (12.1%) followed by LN (7.1%). Conclusion FSGS and LN are the most common primary and secondary GN, respectively. Nephrotic syndrome and acute kidney injury were the major indications for biopsy. LN carried the best prognosis, while vasculitis carried the worst prognosis.
{"title":"Spectrum of glomerulonephritis in adult Egyptians: a single-center retrospective study","authors":"E. Khaled, Elena Ahmed, Kora Mahmoud, Tawfeek Ahmed, Dewidar Noha","doi":"10.4103/jesnt.jesnt_36_22","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_36_22","url":null,"abstract":"Background Glomerulonephritis (GN) is still the main cause of renal morbidity and mortality in the developing world. Knowledge about the characteristics of GN and its regional trends is mandatory for proper management of chronic kidney disease to decrease the incidence of progression to end-stage kidney disease. The aim of this study is to identify the patterns and frequency of glomerular lesions (biopsy-proven). Patients and methods This is a retrospective study that included 140 adult patients who underwent renal biopsies at Menoufia University Hospitals between August 2017 and December 2019. Patient demographics, clinical, laboratory, and histopathological data were recorded. The obtained data were analyzed using descriptive and inferential statistics. Results The studied patients were 72 (51.4%) males and 68 (48.6%) females, and their mean age was 36.11 ± 14.57 years. Focal segmental glomerulosclerosis (FSGS) was the most frequent cause of primary GN (21.4%) followed by membranous GN (13.6%), minimal change disease (5.7%), and membranoproliferative GN (3.6%). Lupus nephritis (LN) was reported as the most common in secondary GN (18.6%), followed by vasculitis (12.1%), amyloidosis (5.7%), thrombotic microangiopathy (4.3%), and infection-related GN (3.6%). The most common presentation was peripheral edema (80.7%), followed by acute kidney injury (14.3%). FSGS (12.1%) was the most common subtype of primary GN associated with renal insufficiency followed by membranous GN (10%). Vasculitis was the most common subtype of secondary GN associated with renal insufficiency (12.1%) followed by LN (7.1%). Conclusion FSGS and LN are the most common primary and secondary GN, respectively. Nephrotic syndrome and acute kidney injury were the major indications for biopsy. LN carried the best prognosis, while vasculitis carried the worst prognosis.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"32874 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132918917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.4103/jesnt.jesnt_19_22
S. Patil, S. Balan, P. Murlidharan, S. Jethwa, Arjun Rajalakshmi
Tuberculosis (TB) is one of the common infections after renal transplantation in developing countries. Patients who receive kidney grafts are at an increased risk for the development of mycobacterial disease than the general population, because of uremia and the immunosuppressants used in the posttransplant period, all of which interfere with T-cell function. Extrapulmonary TB is more common in renal allograft recipients and may present with dissemination or atypical features. Although extrapulmonary TB occurs frequently, isolated ankle joint TB is a rare form of extrapulmonary TB infection. We report here a renal allograft recipient with ankle joint TB presenting 6 months after transplantation with persistent pain in the left ankle joint associated with swelling and mild restriction of joint movement. He was diagnosed to be having an osteomyelitis of the talus bone extending to the navicular and anterior part of the calcaneus. He underwent open debridement and CB-NAAT of the tissue, which showed mycobacterium TB and rifampicin resistance was not detected. He was started on antituberculous treatment. This report highlights the need for a high index of suspicion for diagnosing TB early among renal transplant recipients and diagnostic difficulties of the TB disease due to insidious and nonspecific clinical presentation. Also, the treatment has to be monitored closely due to drug interaction between immunosuppressants and anti-TB drugs.
{"title":"Postrenal transplant tuberculosis of the ankle joint: A case report","authors":"S. Patil, S. Balan, P. Murlidharan, S. Jethwa, Arjun Rajalakshmi","doi":"10.4103/jesnt.jesnt_19_22","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_19_22","url":null,"abstract":"Tuberculosis (TB) is one of the common infections after renal transplantation in developing countries. Patients who receive kidney grafts are at an increased risk for the development of mycobacterial disease than the general population, because of uremia and the immunosuppressants used in the posttransplant period, all of which interfere with T-cell function. Extrapulmonary TB is more common in renal allograft recipients and may present with dissemination or atypical features. Although extrapulmonary TB occurs frequently, isolated ankle joint TB is a rare form of extrapulmonary TB infection. We report here a renal allograft recipient with ankle joint TB presenting 6 months after transplantation with persistent pain in the left ankle joint associated with swelling and mild restriction of joint movement. He was diagnosed to be having an osteomyelitis of the talus bone extending to the navicular and anterior part of the calcaneus. He underwent open debridement and CB-NAAT of the tissue, which showed mycobacterium TB and rifampicin resistance was not detected. He was started on antituberculous treatment. This report highlights the need for a high index of suspicion for diagnosing TB early among renal transplant recipients and diagnostic difficulties of the TB disease due to insidious and nonspecific clinical presentation. Also, the treatment has to be monitored closely due to drug interaction between immunosuppressants and anti-TB drugs.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114722562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.4103/jesnt.jesnt_28_22
M. Mbengue, A. Séne, Carolyn Om’ndus, S. Diagne, M. Faye, A. Niang, A. Lemrabott
Background A sedentary lifestyle is an important risk factor for mortality, especially cardiovascular mortality. This risk is increased in hemodialysis patients owing to the presence of other comorbidities. The aims of this study were to assess physical activity in hemodialysis patients and to figure out factors associated with sedentary lifestyle. Patients and methods This was a cross-sectional, descriptive, analytical study. It was conducted over a 2-month period. The study included patients who had been on regular hemodialysis for at least 6 months. Patients with physical disability were not included. Physical activity was assessed using an accelerometer. Results There were 30 included patients, of whom 22 were male and eight female. The mean age of the patients was 43.40 ± 15.14 years. The average number of steps per day was 7464.32 ± 4166.82 steps/day. The average number of steps per dialysis day was 6605.41 ± 4251.27 steps/day. According to the number of steps per day, 26.7% of patients were sedentary, 26.7% of patients were less active, and 46.6% were active. Factors associated with sedentary behavior were the sex (P=0.028), the age (P=0.001), and the day of dialysis (P=0.0001). Conclusion Sedentary lifestyle was frequent in our study. This high frequency is explained by several factors related to chronic kidney disease and hemodialysis itself.
{"title":"Assessment of physical activity in hemodialysis and factors associated with a sedentary lifestyle","authors":"M. Mbengue, A. Séne, Carolyn Om’ndus, S. Diagne, M. Faye, A. Niang, A. Lemrabott","doi":"10.4103/jesnt.jesnt_28_22","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_28_22","url":null,"abstract":"Background A sedentary lifestyle is an important risk factor for mortality, especially cardiovascular mortality. This risk is increased in hemodialysis patients owing to the presence of other comorbidities. The aims of this study were to assess physical activity in hemodialysis patients and to figure out factors associated with sedentary lifestyle. Patients and methods This was a cross-sectional, descriptive, analytical study. It was conducted over a 2-month period. The study included patients who had been on regular hemodialysis for at least 6 months. Patients with physical disability were not included. Physical activity was assessed using an accelerometer. Results There were 30 included patients, of whom 22 were male and eight female. The mean age of the patients was 43.40 ± 15.14 years. The average number of steps per day was 7464.32 ± 4166.82 steps/day. The average number of steps per dialysis day was 6605.41 ± 4251.27 steps/day. According to the number of steps per day, 26.7% of patients were sedentary, 26.7% of patients were less active, and 46.6% were active. Factors associated with sedentary behavior were the sex (P=0.028), the age (P=0.001), and the day of dialysis (P=0.0001). Conclusion Sedentary lifestyle was frequent in our study. This high frequency is explained by several factors related to chronic kidney disease and hemodialysis itself.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127176142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.4103/jesnt.jesnt_34_22
Mohamed Habli, D. Belal, Ajay K. Sharma, A. Halawa
Immunological barrier posed by preformed antibodies against donor’s human leukocyte antigen (HLA) antigens compounds the situation of global shortage of kidney donors. Pretransplantation sensitization carries a high risk of acute rejection and allograft loss. Therefore, there is a need for careful evaluation of potential recipients, based on HLA typing, HLA match, and comprehensive screening of antibodies (is conceptual). Sensitization events include previous transplantations, blood transfusions, or pregnancies. Despite advances in molecular techniques and solid-phase assays used to identify at-risk patients, kidney transplantation continues to be challenging in patients with calculated panel reactive antibodies greater than 85%. The development of desensitization protocols has been used to overcome acute rejection risk; however, the associated further increase in the risk of infection and malignancy is of significant concern owing to enhanced immunosuppression. The introduction of rituximab, bortezomib, plasmapheresis, and intravenous immunoglobulins has improved the success rate of desensitization protocols. On the contrary, paired (pooled) exchange kidney program has been instrumental in widening access to allografts to highly sensitized patients by offering lesser HLA mismatches. Moreover, desensitization protocols are rather expensive, leading to a high economic burden in the pretransplantation and posttransplantation period. This review aims to discuss the scientific basis and practical issues of managing highly sensitized patients.
{"title":"Transplanting highly sensitized patients: Is it still a reasonable option?","authors":"Mohamed Habli, D. Belal, Ajay K. Sharma, A. Halawa","doi":"10.4103/jesnt.jesnt_34_22","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_34_22","url":null,"abstract":"Immunological barrier posed by preformed antibodies against donor’s human leukocyte antigen (HLA) antigens compounds the situation of global shortage of kidney donors. Pretransplantation sensitization carries a high risk of acute rejection and allograft loss. Therefore, there is a need for careful evaluation of potential recipients, based on HLA typing, HLA match, and comprehensive screening of antibodies (is conceptual). Sensitization events include previous transplantations, blood transfusions, or pregnancies. Despite advances in molecular techniques and solid-phase assays used to identify at-risk patients, kidney transplantation continues to be challenging in patients with calculated panel reactive antibodies greater than 85%. The development of desensitization protocols has been used to overcome acute rejection risk; however, the associated further increase in the risk of infection and malignancy is of significant concern owing to enhanced immunosuppression. The introduction of rituximab, bortezomib, plasmapheresis, and intravenous immunoglobulins has improved the success rate of desensitization protocols. On the contrary, paired (pooled) exchange kidney program has been instrumental in widening access to allografts to highly sensitized patients by offering lesser HLA mismatches. Moreover, desensitization protocols are rather expensive, leading to a high economic burden in the pretransplantation and posttransplantation period. This review aims to discuss the scientific basis and practical issues of managing highly sensitized patients.","PeriodicalId":285751,"journal":{"name":"Journal of The Egyptian Society of Nephrology and Transplantation","volume":"15 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126142305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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